Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients?
OBJECTIVE
This study was designed to analyze the incidence of "dual tachycardia"-ventricular tachycardia (VT) or ventricular fibrillation (VF) preceded by paroxysmal atrial tachycardia (AT) or atrial fibrillation (AF)-in patients receiving dual-chamber implantable cardioverter defibrillators (ICDs).


BACKGROUND
Paroxysmal AT/AF occurs commonly in patients who receive ICDs for the treatment of life-threatening VT/VF. Although AF is associated with an adverse prognosis in the setting of structural heart disease, the relationship between AT/AF and VT/VF is unclear.


METHODS
We followed 537 patients undergoing implantation of the Jewel AF ICD (Model 7250, Medtronic, Minneapolis, Minnesota) for 11.4 +/- 8.2 months. These included 398 patients with a history of at least two episodes of AT or AF during the preceding year as well as 139 patients enrolled because of VT/VF alone.


RESULTS
There were 233 dual tachycardia episodes in 45 patients during follow-up. Overall, 8.9% of episodes detected as VT/VF were dual tachycardias, and 20.3% of patients with VT/VF had at least one dual tachycardia episode. The median duration of AT/AF preceding the first VT/VF detection was 1.09 h (25% to 75% quartile 0.24 to 33.4 h). When AT/AF continued between two consecutive VT/VF detections, the median interdetection interval was 11 min. When AT/AF terminated either because of a ventricular therapy or spontaneously, the median interdetection interval was prolonged to 71 h (p < 0.001).


CONCLUSIONS
Dual tachycardia is common in ICD recipients with a history of AT/AF. The duration of AT/AF preceding the first VT/VF detection is < or =1 h about 50% of the time. Termination of the AT/AF significantly delays the time to the next VT/VF detection.
Stein
Kenneth M
KM
Division of Cardiology, Department of Medicine, Cornell University Medical College, New York, NY, USA. kstein@mail.med.cornell.edu
Euler
David E
DE
Mehra
Rahul
R
Seidl
Karlheinz
K
Slotwiner
David J
DJ
Mittal
Suneet
S
Markowitz
Steven M
SM
Lerman
Bruce B
BB
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000150:complications* / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000503:physiopathology*; D014693:Ventricular Fibrillation / Q000209:etiology / Q000503:physiopathology