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J Am Coll Cardiol, 2002; 40:335-340
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: ARRHYTHMIAS

Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients?

Kenneth M. Stein, MD, FACC*,*, David E. Euler, PhD{dagger}, Rahul Mehra, PhD{dagger}, Karlheinz Seidl, MD{ddagger}, David J. Slotwiner, MD*, Suneet Mittal, MD, FACC*, Steven M. Markowitz, MD, FACC*, Bruce B. Lerman, MD, FACC* Jewel AF Worldwide Investigators

* Division of Cardiology, Department of Medicine, Cornell University Medical College, New York, New York, USA
{dagger} Medtronic Inc., Minneapolis, Minnesota, USA
{ddagger} Herzentrum Ludwigshafen, Ludwigshafen, Germany

Manuscript received July 30, 2001; revised manuscript received March 28, 2002, accepted April 17, 2002.

* Reprint requests and correspondence: Dr. Kenneth M. Stein, Division of Cardiology, Starr-4, The New York Hospital, 525 East 68th Street, New York, New York 10021, USA.
kstein{at}mail.med.cornell.edu

OBJECTIVES: 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 ≤1 h about 50% of the time. Termination of the AT/AF significantly delays the time to the next VT/VF detection.

Abbreviations and Acronyms
  AT
  atrial tachycardia
  AF
  atrial fibrillation
  CI
  confidence interval
  GEE
  generalized estimating equation
  ICD
  implantable cardioverter defibrillator
  SVT
  supraventricular tachycardia
  VF
  ventricular fibrillation
  VT
  ventricular tachycardia




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