Worden Nicole E, Alqasrawi Musab, Mazur Alexander
Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Pacing Clin Electrophysiol. 2016 Dec;39(12):1327-1334. doi: 10.1111/pace.12967. Epub 2016 Nov 20.
Available atrial electrograms in implantable cardioverter defibrillators (ICDs) improve arrhythmia diagnosis, allow monitoring for atrial fibrillation, and may reduce the risk of inappropriate therapies. A recently introduced ICD system using a single-lead with floating atrial electrodes provides diagnostic capability of a dual-chamber system without placing an additional lead. Data on long-term clinical performance of this system are limited.
We retrospectively analyzed data from 35 consecutive patients implanted with Biotronik VR-T DX devices and Linox DX leads. (Biotronik, SE & Co., Berlin, Germany) RESULTS: Of 35 patients (77% male, age 52 ± 11.28 years), 32 were followed for a mean of 432 ± 197 days (range 56-765). During implantation, average preamplified and amplified sinus P-wave amplitudes were 2.61 ± 1.39 mV (range 0.9-6.8 mV) and 8.7 ± 4.51 mV (range 1.4-18 mV), respectively. Despite statistically significant variations, the amplified P-wave amplitude measurements (calculated mean values over 3 months) remained within a clinically acceptable range during follow-up (5.4-8.7 mV). R-wave amplitude and ventricular pacing threshold measurements were stable over time. A total of 13 stored arrhythmia events (three ventricular tachycardia, eight supraventricular tachycardia, two atrial fibrillation) were reviewed. All of them showed readily interpretable atrial electrograms. Eight out of 10 (80%) supraventricular events were correctly classified by the device. Three patients received inappropriate ICD therapies.
The single-lead ICD system using a floating atrial dipole provides reliable recording of atrial signals during sinus rhythm and arrhythmias. Our data suggest that the system may offer diagnostic advantages of a dual-chamber device without potential risks of an additional atrial lead.
植入式心脏复律除颤器（ICD）中可用的心房电图可改善心律失常的诊断，有助于监测心房颤动，并可能降低不适当治疗的风险。最近推出的一种使用带有浮动心房电极的单导联ICD系统，无需额外放置导联即可提供双腔系统的诊断能力。关于该系统长期临床性能的数据有限。
我们回顾性分析了连续35例植入百多力VR-T DX设备和Linox DX导联的患者的数据。（百多力公司，德国柏林）结果：35例患者（77%为男性，年龄52±11.28岁）中，32例平均随访432±197天（范围56 - 765天）。植入期间，平均预放大和放大后的窦性P波振幅分别为2.61±1.39 mV（范围0.9 - 6.8 mV）和8.7±4.51 mV（范围1.4 - 18 mV）。尽管存在统计学上的显著差异，但随访期间放大后的P波振幅测量值（3个月的计算平均值）仍保持在临床可接受范围内（5.4 - 8.7 mV）。R波振幅和心室起搏阈值测量值随时间保持稳定。共回顾了13次存储的心律失常事件（3次室性心动过速、8次室上性心动过速、2次心房颤动）。所有事件均显示心房电图易于解读。10次室上性事件中有8次（80%）被设备正确分类。3例患者接受了不适当的ICD治疗。
使用浮动心房偶极的单导联ICD系统在窦性心律和心律失常期间能可靠记录心房信号。我们的数据表明，该系统可能具有双腔设备的诊断优势，而无额外心房导联的潜在风险。
