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Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator

(2000) CIRCULATION. 101(8). p.878-885
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Abstract
Background: To distinguish prolonged episodes of atrial fibrillation (AF) that require cardioversion from self-terminating episodes that do not, an atrial implantable cardioverter-defibrillator (ICD) must be able to detect AF continuously for extended periods, The ICD should discriminate between atrial tnc tachycardia/flutter (AT), which may be terminated by antitachycardia pacing, and AF, which requires cardioversion. Methods and Results: We studied 80 patients with AT/AF and ventricular arrhythmias who were treated with a new atrial/dual-chamber ICD. During a follow-up period lasting 6 +/- 2 months, we validated spontaneous, device-defined AT/AF episodes by stored electrograms in all patients, In 58 patients, we performed 80 Holter recordings with telemetered atrial electrograms, both to validate the continuous detection of AT/AF and to determine the sensitivity of the detection of AT/AF. Detection was appropriate in 98% of 132 AF episodes and 88% of 190 AT episodes (98% of 128 AT episodes with an atrial cycle length <300 ms). Intermittent sensing of far-field R waves during sinus tachycardia caused 27 inappropriate AT/AF detections: these detections lasted 2.6 +/- 2.0 minutes. AT/AF was detected continuously in 27 of 28 patients who had spontaneous episodes of AT/AF (96%). The device memory recorded 90 appropriate AT/AF episodes lasting >1 hour, for a total of 2697 hours of continuous detection of AT/AF. During Holter monitoring, the sensitivity of the detection of AT/AF (116 hours) was 100%; the specificity of the detection of non-AT/AF rhythms (1290 hours) was 99.99%. Of 166 appropriate episodes detected as AT, 45% were terminated by antitachycardia pacing. Conclusions: A new ICD detects AT/AF accurately and continuously. Therapy may be programmed for long-duration AT/AF, with a low risk of underdetecrion. Discrimination of AT from AF permits successful pacing therapy for a significant fraction of AT.
Keywords
defibrillators, atrial fibrillation, implantable, arrhythmia, atrial flutter, TACHYARRHYTHMIA DETECTION ALGORITHM

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Citation

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Chicago
Swerdlow, Charles D, Wolfgang Schšls, Barbara Dijkman, Werner Jung, Nirav V Sheth, Walter H Olson, Bruce D Gunderson, for the Worldwide Jewel AF Investigators, and Luc Jordaens. 2000. “Detection of Atrial Fibrillation and Flutter by a Dual-chamber Implantable Cardioverter-defibrillator.” Circulation 101 (8): 878–885.
APA
Swerdlow, C. D., Schšls, W., Dijkman, B., Jung, W., Sheth, N. V., Olson, W. H., Gunderson, B. D., et al. (2000). Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. CIRCULATION, 101(8), 878–885.
Vancouver
1.
Swerdlow CD, Schšls W, Dijkman B, Jung W, Sheth NV, Olson WH, et al. Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. CIRCULATION. 2000;101(8):878–85.
MLA
Swerdlow, Charles D, Wolfgang Schšls, Barbara Dijkman, et al. “Detection of Atrial Fibrillation and Flutter by a Dual-chamber Implantable Cardioverter-defibrillator.” CIRCULATION 101.8 (2000): 878–885. Print.
@article{170703,
  abstract     = {Background: To distinguish prolonged episodes of atrial fibrillation (AF) that require cardioversion from self-terminating episodes that do not, an atrial implantable cardioverter-defibrillator (ICD) must be able to detect AF continuously for extended periods, The ICD should discriminate between atrial tnc tachycardia/flutter (AT), which may be terminated by antitachycardia pacing, and AF, which requires cardioversion. 
Methods and Results: We studied 80 patients with AT/AF and ventricular arrhythmias who were treated with a new atrial/dual-chamber ICD. During a follow-up period lasting 6 +/- 2 months, we validated spontaneous, device-defined AT/AF episodes by stored electrograms in all patients, In 58 patients, we performed 80 Holter recordings with telemetered atrial electrograms, both to validate the continuous detection of AT/AF and to determine the sensitivity of the detection of AT/AF. Detection was appropriate in 98\% of 132 AF episodes and 88\% of 190 AT episodes (98\% of 128 AT episodes with an atrial cycle length {\textlangle}300 ms). Intermittent sensing of far-field R waves during sinus tachycardia caused 27 inappropriate AT/AF detections: these detections lasted 2.6 +/- 2.0 minutes. AT/AF was detected continuously in 27 of 28 patients who had spontaneous episodes of AT/AF (96\%). The device memory recorded 90 appropriate AT/AF episodes lasting {\textrangle}1 hour, for a total of 2697 hours of continuous detection of AT/AF. During Holter monitoring, the sensitivity of the detection of AT/AF (116 hours) was 100\%; the specificity of the detection of non-AT/AF rhythms (1290 hours) was 99.99\%. Of 166 appropriate episodes detected as AT, 45\% were terminated by antitachycardia pacing. 
Conclusions: A new ICD detects AT/AF accurately and continuously. Therapy may be programmed for long-duration AT/AF, with a low risk of underdetecrion. Discrimination of AT from AF permits successful pacing therapy for a significant fraction of AT.},
  author       = {Swerdlow, Charles D and Sch\v{s}ls, Wolfgang and Dijkman, Barbara and Jung, Werner and Sheth, Nirav V and Olson, Walter H and Gunderson, Bruce D and Worldwide Jewel AF Investigators, for the  and Jordaens, Luc},
  issn         = {0009-7322},
  journal      = {CIRCULATION},
  keyword      = {defibrillators,atrial fibrillation,implantable,arrhythmia,atrial flutter,TACHYARRHYTHMIA DETECTION ALGORITHM},
  language     = {eng},
  number       = {8},
  pages        = {878--885},
  title        = {Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator},
  url          = {http://dx.doi.org/10.1161/01.CIR.101.8.878},
  volume       = {101},
  year         = {2000},
}

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