[A new dual-chamber defibrillation system: duration, frequency and circadian variation of recurrent supraventricular tachyarrhythmias].
BACKGROUND
The treatment of concomitant atrial tachyarrhythmias in patients with malignant ventricular tachyarrhythmias is a major challenge for new defibrillator devices. Atrial fibrillation is not only responsible for inappropriate ventricular therapies, but also reduced left ventricular performance, especially in patients with heart failure and severely depressed left ventricular function. Furthermore, it is a strong risk factor for the development of thromboembolism.
A new dual-chamber implantable defibrillator is capable of tiered atrial therapies for both regular and irregular atrial tachyarrhythmias. In first investigations a high sensitivity and specificity could be shown as well as a promising therapy efficacy of atrial antitachycardia ramp and burst pacing for the treatment of atrial tachycardias. Atrial ramp pacing has shown to be successful for regular atrial tachyarrhythmias in up to 60 to 70% of all episodes. The results have supported a programming of a high first shock energy for treatment of atrial fibrillation. The incidence of atrial fibrillation in patients with a history of atrial fibrillation or without is much higher in the present investigated patient populations than expected.


CONCLUSIONS
The more complicated and subtle new dual-chamber detection algorithm has proven to be safe and effective both for the detection of ventricular tachycardia but also in terms of an increase of specificity and a reduction of inappropriate ventricular therapies for atrial tachyarrhythmias.
Medizinische Universitätsklinik und Poliklinik II Sigmund-Freud-Strasse 25 D-53105 Bonn, Germany. CWolpert@Uni-Bonn.de
C
C
Wolpert
W
W
Jung
S
S
Herwig
R
R
Schimpf
B
B
Lüderitz
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002940:Circadian Rhythm; D002986:Clinical Trials as Topic; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D015444:Exercise; D006801:Humans; D015337:Multicenter Studies as Topic; D010138:Pacemaker, Artificial; D012008:Recurrence; D012680:Sensitivity and Specificity; D013616:Tachycardia, Sinus / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology