title: Matching approved "nondedicated" hardware to obtain biventricular pacing and defibrillation: feasibility and troubleshooting.
abstract: Biventricular ICDs may offer increased benefit for patients with severe congestive heart failure and ventricular arrhythmia. Currently there are no approved dedicated biventricular ICDs available. Twenty-one consecutive patients who had approved nondedicated hardware implanted for biventricular pacing and defibrillation were included in this study. All device therapies were evaluated using stored electrograms. During mean follow-up at 13 +/- 7 months, 8 (36%) patients had inappropriate shocks. Ventricular fibrillation therapy was delivered for slow ventricular tachycardia because of double counting in two patients. In one patient, AV nodal reentrant tachycardia below detection rate cut off triggered device therapy because of ventricular double counting. Sinus tachycardia or premature atrial contraction initiating AV conduction and ventricular double counting resulted in shocks in five patients. The number of shocks per patient ranged from 1 to 64. Two patients required transient disconnection of the LV lead and subsequent ICD generator replacement for premature battery depletion. Two patients required AV junction ablation and three needed slow pathway ablation. Two patients were treated by upgrading to a device that was capable of a higher atrial tracking rate. The patients with impaired AV conduction or constant ventricular pacing did not have inappropriate therapy for sinus tachycardia or supraventricular arrhythmia. Use of conventional nondedicated hardware for biventricular pacer/defibrillator is feasible but should be considered only in patients with poor AV node function or less likely to require antitachycardic therapy, to avoid ICD double counting of ventricular sensed events and consequent high incidence of inappropriate therapies.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: Logan
authors.initials: L
authors.lastname: Kanagaratnam
authors.forename: Stephen
authors.initials: S
authors.lastname: Pavia
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Nassir
authors.initials: N
authors.lastname: Marrouche
authors.forename: Cathy
authors.initials: C
authors.lastname: Lam
authors.forename: Miguel
authors.initials: M
authors.lastname: Abreu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ching
authors.forename: Mina
authors.initials: M
authors.lastname: Chung
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Mark
authors.initials: M
authors.lastname: Niebauer
authors.forename: Bruce
authors.initials: B
authors.lastname: Wilkoff
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy*