title: Ventricular rate monitoring as a tool to predict and prevent atrial fibrillation-related inappropriate shocks in heart failure patients treated with cardiac resynchronisation therapy defibrillators.
abstract: OBJECTIVE
  Inappropriate implantable cardioverter defibrillators (ICD) therapies have been associated with multiple adverse effects, including worse quality of life and prognosis. We evaluated the possibility of predicting atrial fibrillation (AF)-related inappropriate ICD shocks through continuous monitoring of device diagnostics.
  
  
  METHODS
  1404 ICD patients were prospectively followed in an observational research by 74 Italian cardiology centres. Device diagnostics stored daily information on AF duration and ventricular rate (VR) during AF. Uncontrolled VR was defined as mean VR>80 beats per minute (bpm) and maximum VR>110 bpm. Expert electrophysiologists reviewed the ventricular tachycardia/ventricular fibrillation (VT/VF) episodes electrograms, stored in the device memory, and classified appropriate detections, inappropriate detection mechanisms and ICD therapy outcomes.
  
  
  RESULTS
  Over a median follow-up of 31 months, 511 (36%) patients suffered spontaneous VT/VF, which were treated by ICD shocks in a subgroup of 189 (13%) patients. Inappropriate detections occurred in 232 (16%) patients, and inappropriate ICD shocks in 101 (7%) patients. AF was the cause of inappropriate shocks in 60 patients. AF caused 144 inappropriate shocks: 53% of all inappropriate shocks. The likelihood of experiencing AF-related inappropriate shocks was 2.4% at 1 year and 6% at 5 years. Uncontrolled VR during AF proved to be an independent predictor of AF-related inappropriate shocks (OR=3.02, p=0.006); an alarm set at a VR>90 bpm or 100 bpm was associated with prediction of AF-related inappropriate shocks with a sensitivity of 73% or 62%, respectively.
  
  
  CONCLUSIONS
  AF is the most common cause of inappropriate shocks in ICD patients. Continuous remote monitoring of VR during AF would promptly and efficiently predict AF-related inappropriate shocks.
  
  
  BACKGROUND
  http://clinicaltrials.gov/ct2/show/NCT01007474.
authors.affiliation: Department of Cardiology, San Filippo Neri Hospital, , Rome, Italy.
authors.forename: Renato Pietro
authors.initials: RP
authors.lastname: Ricci
authors.forename: Carlo
authors.initials: C
authors.lastname: Pignalberi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.forename: Domenico
authors.initials: D
authors.lastname: Facchin
authors.forename: Domenico
authors.initials: D
authors.lastname: Catanzariti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morani
authors.forename: Michele
authors.initials: M
authors.lastname: Gulizia
authors.forename: Lorenza
authors.initials: L
authors.lastname: Mangoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Grammatico
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: QUALITY OF CARE AND OUTCOMES