Heart 100:848-854 doi:10.1136/heartjnl-2013-305259
  • Arrhythmias and sudden death
  • Original article

Ventricular rate monitoring as a tool to predict and prevent atrial fibrillation-related inappropriate shocks in heart failure patients treated with cardiac resynchronisation therapy defibrillators

  1. on behalf of the ClinicalService cardiological centres
  1. 1Department of Cardiology, San Filippo Neri Hospital, Rome, Italy
  2. 2Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy
  3. 3Niguarda Ca’ Granda Hospital, Milano, Italy
  4. 4Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
  5. 5S. Maria della Misericordia Hospital, Udine, Italy
  6. 6Santa Maria del Carmine Hospital, Rovereto, Italy
  7. 7Borgo Trento Hospital, Verona, Italy
  8. 8Garibaldi-Nesima Hospital, Catania, Italy
  9. 9EMEA Regional Clinical Centre - Medtronic Clinical Research Institute, Rome, Italy
  10. 10IRCCS Istituto Clinico Humanitas, Rozzano, Italy
  1. Correspondence to Dr Renato Pietro Ricci, Department of Cardiology San Filippo Neri Hospital, Via Martinotti, Rome 20 00135, Italy; renatopietroricci{at}
  • Received 12 November 2013
  • Revised 21 January 2014
  • Accepted 3 March 2014
  • Published Online First 28 March 2014


Objective Inappropriate implantable cardioverter defibrillators (ICD) therapies have been associated with multiple adverse effects, including worse quality of life and prognosis. We evaluated the possibility of predicting atrial fibrillation (AF)-related inappropriate ICD shocks through continuous monitoring of device diagnostics.

Methods 1404 ICD patients were prospectively followed in an observational research by 74 Italian cardiology centres. Device diagnostics stored daily information on AF duration and ventricular rate (VR) during AF. Uncontrolled VR was defined as mean VR>80  beats per minute (bpm) and maximum VR>110 bpm. Expert electrophysiologists reviewed the ventricular tachycardia/ventricular fibrillation (VT/VF) episodes electrograms, stored in the device memory, and classified appropriate detections, inappropriate detection mechanisms and ICD therapy outcomes.

Results Over a median follow-up of 31 months, 511 (36%) patients suffered spontaneous VT/VF, which were treated by ICD shocks in a subgroup of 189 (13%) patients. Inappropriate detections occurred in 232 (16%) patients, and inappropriate ICD shocks in 101 (7%) patients. AF was the cause of inappropriate shocks in 60 patients. AF caused 144 inappropriate shocks: 53% of all inappropriate shocks. The likelihood of experiencing AF-related inappropriate shocks was 2.4% at 1 year and 6% at 5 years. Uncontrolled VR during AF proved to be an independent predictor of AF-related inappropriate shocks (OR=3.02, p=0.006); an alarm set at a VR>90 bpm or 100 bpm was associated with prediction of AF-related inappropriate shocks with a sensitivity of 73% or 62%, respectively.

Conclusions AF is the most common cause of inappropriate shocks in ICD patients. Continuous remote monitoring of VR during AF would promptly and efficiently predict AF-related inappropriate shocks.

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