RT Journal Article
SR Electronic
T1 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
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 848
OP 854
DO 10.1136/heartjnl-2013-305259
VO 100
IS 11
A1 Ricci, Renato Pietro
A1 Pignalberi, Carlo
A1 Landolina, Maurizio
A1 Santini, Massimo
A1 Lunati, Maurizio
A1 Boriani, Giuseppe
A1 Proclemer, Alessandro
A1 Facchin, Domenico
A1 Catanzariti, Domenico
A1 Morani, Giovanni
A1 Gulizia, Michele
A1 Mangoni, Lorenza
A1 Grammatico, Andrea
A1 Gasparini, Maurizio
A1 on behalf of the ClinicalService cardiological centres
YR 2014
UL http://heart.bmj.com/content/100/11/848.abstract
AB 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. Clinical trial registration http://clinicaltrials.gov/ct2/show/NCT01007474