Swerdlow C D, Schsls W, Dijkman B, Jung W, Sheth N V, Olson W H, Gunderson B D
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Circulation. 2000 Feb 29;101(8):878-85. doi: 10.1161/01.cir.101.8.878.
To distinguish prolonged episodes of atrial fibrillation (AF) that require cardioversion from self-terminating episodes that do not, an atrial implantable cardioverter-defibrillator (ICD) must be able to detect AF continuously for extended periods. The ICD should discriminate between atrial tachycardia/flutter (AT), which may be terminated by antitachycardia pacing, and AF, which requires cardioversion.
We studied 80 patients with AT/AF and ventricular arrhythmias who were treated with a new atrial/dual-chamber ICD. During a follow-up period lasting 6+/-2 months, we validated spontaneous, device-defined AT/AF episodes by stored electrograms in all patients. In 58 patients, we performed 80 Holter recordings with telemetered atrial electrograms, both to validate the continuous detection of AT/AF and to determine the sensitivity of the detection of AT/AF. Detection was appropriate in 98% of 132 AF episodes and 88% of 190 AT episodes (98% of 128 AT episodes with an atrial cycle length <300 ms). Intermittent sensing of far-field R waves during sinus tachycardia caused 27 inappropriate AT/AF detections; these detections lasted 2.6+/-2.0 minutes. AT/AF was detected continuously in 27 of 28 patients who had spontaneous episodes of AT/AF (96%). The device memory recorded 90 appropriate AT/AF episodes lasting >1 hour, for a total of 2697 hours of continuous detection of AT/AF. During Holter monitoring, the sensitivity of the detection of AT/AF (116 hours) was 100%; the specificity of the detection of non-AT/AF rhythms (1290 hours) was 99.99%. Of 166 appropriate episodes detected as AT, 45% were terminated by antitachycardia pacing.
A new ICD detects AT/AF accurately and continuously. Therapy may be programmed for long-duration AT/AF, with a low risk of underdetection. Discrimination of AT from AF permits successful pacing therapy for a significant fraction of AT.
为了区分需要心脏复律的持续性心房颤动（AF）发作和可自行终止的发作，植入式心房心律转复除颤器（ICD）必须能够长时间持续检测AF。ICD应能区分可能通过抗心动过速起搏终止的房性心动过速/心房扑动（AT）和需要心脏复律的AF。
我们研究了80例患有AT/AF和室性心律失常并接受新型心房/双腔ICD治疗的患者。在为期6±2个月的随访期间，我们通过所有患者存储的心电图验证了设备定义的自发性AT/AF发作。在58例患者中，我们进行了80次带有遥测心房电图的动态心电图记录，以验证AT/AF的持续检测并确定AT/AF检测的敏感性。在132次AF发作中有98%以及190次AT发作中有88%（心房周期长度<300 ms的128次AT发作中有98%）检测正确。窦性心动过速期间对远场R波的间歇性感知导致27次不适当的AT/AF检测；这些检测持续2.6±2.0分钟。在28例有自发性AT/AF发作的患者中，27例（96%）持续检测到AT/AF。设备存储器记录了90次持续>1小时的适当AT/AF发作，AT/AF持续检测总计2697小时。在动态心电图监测期间，AT/AF检测（116小时）的敏感性为100%；非AT/AF心律检测（1290小时）的特异性为99.99%。在检测为AT的166次适当发作中，45%通过抗心动过速起搏终止。
新型ICD能准确持续地检测AT/AF。对于长时间的AT/AF可设置治疗程序，漏检风险低。区分AT和AF可使相当一部分AT成功进行起搏治疗。
