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• W4377015876 abstract "The Biotronik Dx ICD system is a single lead pacing system with ability to sense atrial signals via floating atrial dipole, developed to provide advantages of atrial EGMs without risks and cost of additional atrial lead using SMART algorithm (Fig 1,E). Long term follow-up data with this system is scant and conflicting. To evaluate long term follow up data of Dx ICD system. We prospectively analysed data of 68 pts with Dx ICD implantation from April 2017-July 2021. Implant characteristics, device f/u reports of patients along with RM were analysed.Primary outcome was percentage of appropriate therapies for VT/VF. Secondary outcome was percentage of inappropriate classification and therapy of either SVT as VT/VF or withholding therapy for a VT/VF, analysis of RM transmission with percentage of device classifications. P/R wave sensing, lead impedance trends were monitored. Total of 68 pts (33F, 63.3+10.9 y,RM in 60) were implanted with Dx ICD system, followed up for mean duration of 3.2+1.1y. SMART was turned ON in all but one at discharge where sensed A amplitude at discharge was <0.4mV. 4115 spontaneous arrhythmia episodes were recorded in 68 pts, of which 199 episodes were classified as VT/VF by the device and 3916 as SVT. Manual interpretation revealed 944 episodes (22.95%) inappropriately classified by device (Fig1). Reasons of inappropriate classification and therapy of SVT as VT/VF were atrial undersensing despite atrial gain algorithm, Far-field protection (FFP) period that caused blanked P waves and lack of MorphMatch when SMART is ON (Figure1A-E). It was found that device switched to single chamber discrimination during arrythmia detection when there was evidence of atrial undersensing by device in 1 patient. In addition, during routine f/u, there were 17 patients (19%) in whom the sensed P wave amplitude dropped <1mV and hence mode converted to VVI. CXR revealed that atrial dipole had migrated cranially to SVC RA junction. Summary of device misclassification is in Table 1. 22/68 pts had inappropriate classification of SR as AT episodes (898 episodes) which displayed 50 Hz low amplitude noise only on atrial lead and not on RV lead which can be explained by zero band behaviour and R wave oversensing was thcause in 1 pt.. (Fig 1, F) Our experience with Dx-ICD technology is the largest single center experience yet. Atrial sensing issues and exclusion of morphology criteria from SMART contribute to high number of arrhythmia misclassifications on follow up." @default.
• W4377015876 created "2023-05-19" @default.
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• W4377015876 date "2023-05-01" @default.
• W4377015876 modified "2023-10-16" @default.
• W4377015876 title "PO-05-081 SINGLE LEAD IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR SYSTEM (ICD) WITH A FLOATING ATRIAL SENSING DIPOLE: LONG TERM FOLLOW UP WITH LIMITATIONS OF THE SMART ALGORITHM" @default.
• W4377015876 doi "https://doi.org/10.1016/j.hrthm.2023.03.1494" @default.
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