Atrial signal amplitude predicts atrial high-rate episodes in implantable cardioverter defibrillator patients: Insights from a large database of remote monitoring transmissions

Massimo Zecchin, Francesco Solimene, Antonio D'Onofrio, Gabriele Zanotto, Saverio Iacopino, Carlo Pignalberi, Valeria Calvi, Giampiero Maglia, Paolo Della Bella, Fabio Quartieri, Antonio Curnis, Mauro Biffi, Alessandro Capucci, Fabrizio Caravati, Gaetano Senatore, Matteo Santamaria, Fabio Lissoni, Michele Manzo, Massimiliano Marini, Massimo GiammariaAntonio Rapacciuolo, Gianfranco Sinagra, Daniele Giacopelli, Alessio Gargaro, Ennio C Pisanò

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Parameters measured during implantable cardioverter defibrillator (ICD) implant also depend on bioelectrical properties of the myocardium. We aimed to explore their potential association with clinical outcomes in patients with single/dual-chamber ICD and cardiac resynchronization therapy defibrillator (CRT-D).

Methods: In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by the occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA), and atrial high-rate episode lasting ≥24 hours (24 h AHRE).

Results: In a cohort of 2976 patients (58.1% ICD) with a median follow-up of 25 months, event rates were 3.1/100 patient-years for all-cause mortality, 18.1/100 patient-years for VA, and 9.3/100 patient-years for 24 h AHRE. At univariate analysis, baseline shock impedance was consistently lower in groups with events than without, with a 40 Ω cutoff that better identified high-risk patients. However, at multivariable analysis, the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint. Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 24 h AHRE than in those without (2.45 [IQR: 1.65-3.85] vs 3.51 [IQR: 2.37-4.67] mV, P < .01). The adjusted HR for 24 h AHRE in patients with atrial sensing >1.5 mV vs those with values ≤1.5 mV was 0.52 (95% CI: 0.33-0.83), P = .006.

Conclusions: Although lower baseline shock impedance was observed in patients with events, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of atrial arrhythmia.

Original languageEnglish
Pages (from-to)353-362
Number of pages10
JournalJournal of Arrhythmia
Volume36
Issue number2
DOIs
Publication statusPublished - Apr 2020

Fingerprint

Dive into the research topics of 'Atrial signal amplitude predicts atrial high-rate episodes in implantable cardioverter defibrillator patients: Insights from a large database of remote monitoring transmissions'. Together they form a unique fingerprint.

Cite this