Abstract
Dual chamber ICD capable of providing dual chamber pacing (DDD) and ventricular arrhythmia therapy is now available. We report our experience of clinical performance of dual chamber ICDs amongst Chinese population.
Methods: 9 patients (6 men and 3 women) received dual chamber ICDs, mean age 50 ± 18.8 years. The indications were ventricular fibrillation (VF) [5], hemodynamic intolerant ventricular tachycardia (VT) [3] and unexplained syncope plus positive induction of VF [1]. The underlying cardiac pathology were congenital LQT syndrome(1), hypertrophic cardiomyopathy [2], coronary artery disease [2], rheumatic valvular disease [1], Brugada syndrome [1], arrhythmogenic right ventricular dysplasia [1] and idiopathic VF [1]. Four patients have documented paroxysmal atrial fibrillation (AF). All patients have defibrillation thresholds (DFT) determined with a binary search protocol starting at 12 joules (J) at implantation.
Results: A total of 34 episodes of VF were induced at implantation with mean DFT 13.8 ± 7 J. The average shocking impedance was 40 ± 3.6 Ω. The mean acute P wave measured 3.3 ± 1.3 mV and R wave measured 13.2 ± 3.2 mV. Atrial and ventricular thresholds, at pulse width 0.5 ms, averaged 0.8 ± 0.4 V and 0.4 ± 0.2 V. During follow-up period, 16 episodes of VF were documented and were successfully treated with the first programmed shock. In the patient with LQT syndrome, DDD was initiated to prevent pause-dependant VF. Three episodes of inappropriate therapy (15.8%) were delivered. One patient experienced 2 shocks after exercise. Stored electrograms showed sinus tachycardia with first degree heart block which was misdiagnosed as VT with retrograde 1:1 conduction. Another inappropriate therapy occurred with AF with fast ventricular response within the VF zone and VT therapy inhibitor was disabled.
Conclusion: Dual chamber ICD allows combined benefits of DDD and VT/VF therapy. Storage of both atrial and ventricular electrograms provide more information in elucidation of nature of dysarrhythmias. Inappropriate shocks, though reduced, are still possible and the rigid algorithms of SVT discrimination from VT will need further published.
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References
The Antiarrhythmic versus Implantable Defibrillators (AVID) Investigators. A comparison of anti-arrhythmic drug therapy with implantable defibrillators in patient resusitated from near-fatal ventricular arrhythmias. N Engl J Med 1997;337:1576–1583
Grimm W, Flores BF, Marchlinski FE. Electrocardiographically documented unnecessary, spontaneous shocks in 241 patients with implantable cardioverter-defibrillator. PACE 1992;15:1667–1673.
Nunain SO, Roelke M, Trouton T, et al. Limitations and late complications of third-generation automatic cardioverterdefibrillators. Circulation 1995;91:2204–2213
Johnson N, Marchlinski FE. The need to enhance diagnostic specificity toward device response to supraventricular rhythms and the risk of induced ventricular arrhythmias. J Am Coll Cardiol 1991;18:1418–1422.
Olson WH, Bardy GH, Mehra R, et al. Onset and stability for ventricular tachyarrythmia detection in an implantable cardioverter-defibrillator. In: Computers in Cardiology. New York: IEEE Press, 1987, 167–170.
Swerdlow C, Chen P, Kass R, et al. Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 1994;23:1342–1355.
Higgins SL, Lee RS, Kramer RL. Stability: An ICD detection criteria for discriminating atrial fibrillation from ventricular tachycardia. J Cardiovasc Electrophysiol 1995;6:1081–1088.
Neuzner J, Pitschner HF, Schlepper M. Programmable VT detection enhancements in implantable cardioverter defibrillator therapy. PACE 1995;18:539–547.
Brachmann J, Seidl K, Hauer B, et al. Intracardiac electrogram width measurement for improved tachycardiac discrimination: Initial results of a new implantable cardioverter-defibrillator. J Am Coll Cardiol 1996;27(Suppl):96A (abstract).
Grimm W, Flores BT, Marchlinski FE. Symptoms and electrocardiographically documented rhythm preceding spontaneous shocks in patients with implantable cardioverter defibrillators. Am J Cardiol 1993;71:1415–1418.
Marchlinski FE, Callans DJ, Gottlieb CD, et al. Benefits and lessons learned from stored electrogram information in implantable defibrillators. J Cardiovasc Electrophysiol 1995;6(Pt 1):832–851.
Lavergne T, Daubert JC, Chauvin M, et al. Preliminary clinical experience with the first dual chamber pacemaker defibrillator. PACE 1997;20[Pt II]:182–188.
Greenberg RM, Degeratu FT. Use of atrial and ventricular electrograms from a dual chamber implantable cardioverter defibrillator to elucidate a complex dyshythmia. PACE 1998;21:2002–2004.
Tang C, Schwartz M, Yeung LW. Atrial diagnostics in a tiered therapy implantable defibrillators. Can L Cardiol 1997;13:446–448.
Geelen P, Lorga A, Chauvin M, et al. The value of DDD pacing in patients with an implantable cardioverter defibrillator. PACE 1997;20:177–181.
Best P, Hayes DL, Stanton MS. Potential usage of dual chamber pacing in implantable cardioverter defibrillators. PACE 1997;20:1079 (abstract).
Iskos D, Fahy GJ, Lurie KG, et al. Physiologic cardiac pacing in patients with contemporary implantable cardioverterdefi brillators. Am J Cardiol 1998;82:66–71.
Glikson M, Hayes DL, Nishimura RA. Newer clinical applications of pacing. J Cardiovasc Electrophysiol 1997;8:1190–1203.
Moss AJ, Liu JE, Gottlieb S, et al. Efficacy of permanent pacing in the management of high-risk patients with long QT syndrome. Circulation 1991;84:1524–1529.
Borggrefe M, Chen X, Martinez-Rubio, et al. The role of implantable cardioverter defibrillators in dilated cardiomyopathy. Am Heart J 1994;127:1145–1150.
Eldar M, Griffin J, Van Hare GF, et al. Combined use of beta-adrenergic blocking agents and long term cardiac pacing for patients with the Long QT Syndrome. J Am Coll Cardiol 1992;20:830–837.
Swerdlow C, Sheth N, Olson WH, for the Worldwide Jewel AF investigators. Clinical performance of a pattern based, dual-chamber algorithm for discrimination of ventricular from supraventricular arrhythmias. PACE 1998;21:4[Pt II]:800 (abstract).
Wolpert C, Jung W, Scholl C, et al. Electrical defibrillator. Proarrhythmia: Induction of inappropriate atrial therapies due to far-field R wave oversensing in a new dual chamber. J Cardiovasc Electrophysiol 1998;9:859–863.
Deshmukh P, Anderson K. Myopotential sensing by a dual chamber implantable cardioverter defibrilltor: Two case reports. J Cardiovasc Electrophysiol 1998;9:767–772.
Gregoratos G, Cheitlin MD, Conill A, et al. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol 1998;31:1175–1209.
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Fan, K., Lee, K. & Lau, C.P. Dual Chamber Implantable Cardioverter Defibrillator Benefits and Limitations. J Interv Card Electrophysiol 3, 239–245 (1999). https://doi.org/10.1023/A:1009847707872
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DOI: https://doi.org/10.1023/A:1009847707872