Top

Gepubliceerd in:

01-06-2008 | review article

Diagnostic tools for atrial tachyarrhythmias in implantable pacemakers: a review of technical options and pitfalls

Auteurs: W. G. de Voogt, N. M. van Hemel

Gepubliceerd in: Netherlands Heart Journal | Uitgave 6/2008

Abstract

Background. Correct pacemaker (PM) diagnosis of paroxysmal atrial tachyarrhythmias is crucial for their prevention and intervention with specific atrial pacing programmes. The PM mode switch to only ventricular pacing after detection of atrial tachyarrhythmias is often used as the parameter to quantify the ‘burden’ of atrial tachyarrhythmias.

Objectives. This review addresses potential errors in the detection and diagnosis of atrial tachyarrhythmias, sometimes resulting in incorrect mode switches. The interpretation of PM-stored data of patients with atrial tachyarrhythmias and the results of trials of pace prevention and intervention can be better appreciated with more insight into the technical options and pitfalls.

Results. Literature and clinical experience demonstrate that the correctness of PM-derived diagnosis of atrial tachyarrhythmias depends on 1) the sensitivity setting to detect the onset and perpetuation of atrial tachyarrhythmias frequently characterised by variable and low-voltage signals, 2) the rejection of far-field R wave sensing by the atrial sense amplifier, 3) the facility for verification of mode switches by a high-quality intracardiac registration of the nonmodified atrial electrogram. The configuration of the atrial lead also contributes to the diagnostic performance of the PM.

Conclusion. Not only pacing algorithms and diverse technical PM features but also the atrial lead configuration are currently the limiting factors to the fully reliable, automated detection and diagnosis of atrial tachyarrhythmias. If these technical shortcomings can be improved, better signal processing will result. Then atrial pacing to prevent or suppress atrial tachyarrhythmias will be more justified. (Neth Heart J 2008;16:201-10.)

vorige artikel The effect of physical, social and psychological factors on drug compliance in patients with mild hypertension

volgende artikel European National Society Cardiovascular Journals

Haissaguerre M, Shah DC, Jais P, Hocini M, Yamane T, Deisenhofer I, et al. Mapping-guided ablation of pulmonary veins to cure atrial fibrillation. Am J Cardiol 2000;86:K9-K19.

Pappone C, Santinelli V, Manguso F, Vicedomini G, Gugliotta F, Augello G, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation 2004;109:327-34.

Pappone C, Rosanio S. Evolution of non-pharmacological curative therapy for atrial fibrillation. Where do we stand today? Int J Cardiol 2003;88:135-42.

Jessurun ER, van Hemel NM, Defauw JA, Stofmeel MA, Kelder JC, de la Riviere AB, et al. Results of maze surgery for lone paroxysmal atrial fibrillation. Circulation 2000;101:1559-67.

Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Vicedomini G, et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation 2000;102:2619-28.

Hsu LF, Jais P, Sanders P, Garrigue S, Hocini M, Sacher F, et al. Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 2004;351:2373-83.

Cox JL. Evolving applications of the maze procedure for atrial fibrillation. Ann Thorac Surg 1993;55:578-80.

Cox JL. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg 1991;101:584-92.

Cox JL, Schuessler RB, D’Agostino HJ Jr, Stone CM, Chang BC, Cain ME, et al. The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 1991;101:569-83.

10.

Wellens HJ, Lau CP, Luderitz B, Akhtar M, Waldo AL, Camm AJ, et al. Atrioverter: an implantable device for the treatment of atrial fibrillation. Circulation 1998;98:1651-6.

11.

Israel CW, Gronefeld G, Li YG, Hohnloser SH. Usefulness of atrial pacing for prevention and termination of atrial tachyarrhythmias in a patient with persistent atrial fibrillation. Pacing Clin Electrophysiol 2002;25:1527-9.

12.

Carlson MD, Ip J, Messenger J, Beau S, Kalbfleisch S, Gervais P, et al. A new pacemaker algorithm for the treatment of atrial fibrillation: results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT). J Am Coll Cardiol 2003;42:627-33.

13.

Padeletti L, Purerfellner H, Adler SW, Waller TJ, Harvey M, Horvitz L, et al. Combined efficacy of atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial tachyarrhythmia. J Cardiovasc Electrophysiol 2003;14:1189-95.

14.

Nowak B, McMeekin J, Knops M, Wille B, Schroder E, Moro C, et al. Validation of dual-chamber pacemaker diagnostic data using dual-channel stored electrograms. Pacing Clin Electrophysiol 2005; 28:620-9.

15.

Schuchert A, Lepage S, Ostrander JJ, Bos RJ, Gwechenberger M, Nicholls A, et al. Automatic analysis of pacemaker diagnostic data in the identification of atrial tachyarrhythmias in patients with no prior history of them. Europace 2005;7:242-7.

16.

Israel CW. Analysis of mode switching algorithms in dual chamber pacemakers. Pacing Clin Electrophysiol 2002;25:380-93.

17.

Israel CW, Gronefeld G, Ehrlich JR, Hohnloser SH. Suppression of atrial tachyarrhythmias by pacing. J Cardiovasc Electrophysiol 2002;13:S31-S39.

18.

Israel CW, Hugl B, Unterberg C, Lawo T, Kennis I, Hettrick D, et al. Pace-termination and pacing for prevention of atrial tachyarrhythmias: results from a multicenter study with an implantable device for atrial therapy. J Cardiovasc Electrophysiol 2001;12:1121-8.

19.

Padeletti L, Pieragnoli P, Ciapetti C, Colella A, Musilli N, Porciani MC, et al. Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia. Am Heart J 2001;142:1047-55.

20.

de Voogt W, van Hemel N, de Vusser P, Mairesse GH, Van Mechelen R, Koistinen J, et al. No evidence of automatic atrial overdrive pacing efficacy on reduction of paroxysmal atrial fibrillation. Europace 2007;9:798-804.

21.

Camm AJ, Sulke N, Edvardsson N, Ritter P, Albers BA, Ruiter JH, et al. Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: the AFTherapy study. Europace 2007;9:1110-8.

22.

de Voogt WG, van Hemel NM, van de Bos AA, Koistinen J, Fast JH. Verification of pacemaker automatic mode switching for the detection of atrial fibrillation and atrial tachycardia with Holter recording. Europace 2006;8:950-61.

23.

Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett EL. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 1994;89:224-7.

24.

Patten M, Maas R, Bauer P, Luderitz B, Sonntag F, Dluzniewski M, et al. Suppression of paroxysmal atrial tachyarrhythmias – results of the SOPAT trial. Eur Heart J 2004;25:1395-404.

25.

Ziegler PD, Koehler JL, Mehra R. Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm 2006;3:1445-52.

26.

Israel CW, Ehrlich JR, Gronefeld G, Klesius A, Lawo T, Lemke B, et al. Prevalence, characteristics and clinical implications of regular atrial tachyarrhythmias in patients with atrial fibrillation: insights from a study using a new implantable device. J Am Coll Cardiol 2001;38:355-63.

27.

Padeletti L, Santini M, Boriani G, Botto G, Capucci A, Gulizia M, et al. Temporal variability of atrial tachyarrhythmia burden in bradycardia-tachycardia syndrome patients. Eur Heart J 2005;26: 165-72.

28.

Israel CW, Neubauer H, Ossowski A, Hohnloser SH. Why did mode switching occur? Pacing Clin Electrophysiol 2000;23:1422-4.

29.

Purerfellner H, Gillis AM, Holbrook R, Hettrick DA. Accuracy of atrial tachyarrhythmia detection in implantable devices with arrhythmia therapies. Pacing Clin Electrophysiol 2004;27:983-92.

30.

Nowak B, Kracker S, Rippin G, Horstick G, Vincent A, Geil S, et al. Effect of the atrial blanking time on the detection of atrial fibrillation in dual chamber pacing. Pacing Clin Electrophysiol 2001;24:496-9.

31.

Fitts SM, Hill MR, Mehra R, Gillis AM. High rate atrial tachyarrhythmia detections in implantable pulse generators: low incidence of false-positive detections. The PA Clinical Trial Investigators. Pacing Clin Electrophysiol 2000;23:1080-6.

32.

Barold SS. Far-field R wave sensing causing prolongation of the atrial escape interval of DDD pacemakers with atrial-based lower rate timing. Pacing Clin Electrophysiol. 2003;26:2188-91.

33.

De Voogt WG, Van Mechelen R, van den Bos AA, Scheffer M, van Hemel NM, Levine PA. Electrical characteristics of low atrial septum pacing compared with right atrial appendage pacing. Europace 2005;7:60-6.

34.

Goethals M, Timmermans W, Geelen P, Backers J, Brugada P. Mode switching failure during atrial flutter: the ‘2:1 lock-in’ phenomenon. Europace 2003;5:95-102.

35.

Ruiter JH, de Voogt W.G., Binner J, Brunekreeft J, van Rooijen H. High atrial sensitivity: assessment of the incidence of far field Rwave and myopotential sensing (abstract). Pacing Clin Electrophysiol 1999;19:187 A.

36.

de Voogt W, van Hemel N, Willems A, Visser J, Chitre Y, Bornzin G, et al. Far-field R-wave reduction with a novel lead design: experimental and human results. Pacing Clin Electrophysiol 2005;28:782-8.

37.

van Hemel NM, Wohlgemuth P, Engbers JG, Lawo T, Nebaznivy J, Taborsky M, et al. Form analysis using digital signal processing reliably discriminates far-field R waves from P waves. Pacing Clin Electrophysiol 2004;27:1615-24.

38.

Lewalter T, Tuininga Y, Frohlig G, Remerie S, Eberhardt F, Schmidt J, et al. Morphology-enhanced atrial event classification improves sensing in pacemakers. Pacing Clin Electrophysiol 2007;30:1455-63.

39.

Shlevkov N, Yang A, Schrickel JW, Schwab JO, Bielik H, Lickfett L, et al. Role of high frequency atrial pacing for the termination of acute atrial fibrillation and atypical atrial flutter. Pacing Clin Electrophysiol 2007;30:322-32.

Titel: Diagnostic tools for atrial tachyarrhythmias in implantable pacemakers: a review of technical options and pitfalls
Auteurs: W. G. de Voogt
N. M. van Hemel
Publicatiedatum: 01-06-2008
Uitgeverij: Bohn Stafleu van Loghum
Gepubliceerd in: Netherlands Heart Journal / Uitgave 6/2008
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI: https://doi.org/10.1007/BF03086146

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 6/2008

Einthoven Dissertation Prizes 2008

Asymptomatic papillary fibroelastoma of the aortic valve

Interventional cardiology and general cardiology: divided by a common speciality?

Atrial pacing for rhythm control of atrial fibrillation

Chest pain in the emergency room: value of the HEART score

European National Society Cardiovascular Journals