The role of atrial fibrillation detection in the discrimination of arrhythmias in patients with implantable cardioverter-defibrillator

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The role of atrial fibrillation detection in the discrimination of arrhythmias in patients with implantable cardioverter-defibrillator

Journal Title: W Dobrym Rytmie - Year 2012, Vol 4, Issue 25

Abstract

In landmark randomized clinical trials inappropriate therapy is reported in 9-26% of patients. The most important reason of this ICD intervention are paroxysms of atrial fibrillation. History of AF and patient age below 70 years are most important factors which increase the risk of inappropriate shock (HR 2,0 and 1,8 respectively). Patients in whom heart rate during AF is higher than 110 bpm are at extremely high risk of shocks due to AF. Inappropriate detection causes inappropriate therapy which not only decrease quality of life but also can influence prognosis. The possibility of ICD therapy is lower when VT detection is set to heart rate over 176 bpm. Proper detection of atrial fibrillation not only reduces the incidence of high voltage therapy but also could improve prognosis when detects clinically silent AF. Dual-chamber ICD seemed to better distinguish SVT and VT although higher rate of peri-procedural complications is observed. Current knowledge does not justify routine use of DDDCD in patients without indications for permanent pacing, although they reduce the rate of inappropriate interventions and allow to diagnose new onset of AT/AF thus should be consider in patients with high risk of thromboembolic events and SVT with high rate ventricular response.<br/><br/>

Authors and Affiliations

Przemysław Mitkowski

Keywords

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EP ID EP53631
DOI 10.5604/18967892.1026295
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