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Updated: May 8, 2025
A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Arrhythmia Detection in Atrioventricular, Single-Lead, Floating Atrial Dipole ICD Systems Compared with Conventional
Flora Diana Gausz1, Kom Nangob Manuela Lena1,2, Paul Emmanuel Gedeon1,3
1Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary.
Background:
An atrioventricular defibrillator system with a floating atrial dipole (VDD ICD) can provide atrial sensing by a single lead. Our aim was to compare the arrhythmia detection efficacy of VDD ICDs with conventional single- (VVI) and dual-chamber (DDD) defibrillators.
Methods:
Data from consecutive patients undergoing ICD implantation were retrospectively analyzed. The primary endpoint was the incidence of device-detected, new-onset atrial arrhythmias, while secondary endpoints were sensing parameters, complication rates, incidence of appropriate/inappropriate ICD therapy, arrhythmic/heart failure-related hospitalizations, and all-cause mortality.
Results:
A total of 256 patients (mean age 64 ± 12 years, male 75%, primary prophylaxis 28%, mean follow-up 3.7 ± 2.4 years) were included (VVI: 93, VDD: 94, DDD: 69). Atrial arrhythmia episodes were detected more frequently by VDD systems compared to VVI ICDs (aHR 7.087; 95% CI 2.371-21.183; p < 0.001), and at a rate similar to that of DDD ICDs (aHR 1.781; 95% CI 0.737-4.301; p = 0.200). The rate of inappropriate shocks was not different among the three ICD systems.
Conclusion:
VDD devices revealed an advantage in atrial arrhythmia detection compared to VVI ICDs and were non-inferior to DDD systems. Their main indication may be closer monitoring in high-risk patients with atrial arrhythmias to help therapy optimization and not the improvement of tachycardia discrimination.
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