This meta-analysis was performed in adherence to the Population, Intervention, Comparison, and Outcome (PICO) framework, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines 7 and MOOSE (Meta-analysis of Observational Studies in Epidemiology) checklist on the quality of reporting of meta-analyses as shown in the Supplementary table S1 and S3. Hence, we performed this meta-analysis to review the atrial sensing performance of VDD-ICD using an atrial floating dipole in the detection of new-onset atrial high-rate episodes (AHREs) or subclinical atrial fibrillation (SCAF) and compare it with VVI- and/or DDD-ICD. The concept of atrial sensing dipole has been proven safe and functional, meeting predefined clinical safety and efficacy of significantly higher than 90%.
The VDD-ICD was designed to amplify and filter the signals in order to maximize atrial sensing and minimize far-field oversensing of ventricular signals. There are two different configurations of the lead design: a 15 and 17 cm version based on the distance between the distal lead tip and mid-point of atrial dipole. The atrial dipole spacing covers a relatively large area of atrial surface of 49 mm 2 which provides flexibility in positioning within the atrium in order to improve stability of atrial signal. 5 This in turn influences decision relating to initiation of anticoagulation for stroke prophylaxis.Ī single lead ICD (VDD-ICD) system with a floating atrial sensing dipole has been developed in early 2000s in order to improve the diagnostic capacity of atrial arrhythmias. 4Ītrial tachyarrhythmias detected on atrial leads, such as device-detected AF, occur frequently in patients with cardiac implantable electronic devices (CIEDs) and are associated with an increased risk of stroke. 3 Recent publication by Ahmed et al by looking at impact of insurance status on ICD implantation practice patterns based on National Cardiovascular Data Registry ICD registry found that among patients without a clear indication for pacing, the uninsured were more likely to receive single- versus dual-chamber ICDs compared to those with insurance in which the apparent difference remains unclear, which requires further study. Ueda et al showed that only two patients (6.0%) of VVI-ICD cohort required to undergo additional atrial lead insertion for bradycardia indication. Advantages in implantation of dual-chamber ICD were presumed better discrimination between supraventricular and ventricular arrhythmias to reduce inappropriate therapies, allow monitoring of atrial fibrillation (AF), and to avoid an additional procedure to place an atrial lead if the need for bradycardia pacing arises. There is no clear consensus to guide the selection between single- and dual-chamber ICD. 1 Data from international registries suggested that more patients received dual-chamber ICD (DDD-ICD) rather than single-chamber ICD (VVI-ICD) for primary prevention despite the indication for atrial pacing being absent. Implantable cardioverter defibrillator (ICD) has become established as a guideline-directed recommendation for primary and secondary prevention of sudden cardiac death. In conclusion, this meta-analysis reveals that the use of floating atrial sensing dipole in VDD-ICD increases the detection of new-onset AHREs or SCAF when compared to VVI-ICD, with similar atrial sensing performance to DDD-ICD. Rate of AHREs detection observed in VDD-ICD was not statistically different when compared to the only group with DDD-ICD from SENSE trial. This difference was more apparently seen in the comparison between VDD-ICD and VVI-ICD. VDD-ICD has a higher likelihood of detecting AHREs or SCAF as compared to VVI-/DDD-ICD.
Median follow-up was from 365 days to 847 days. Three prospective studies were identified and total of 991 participants were included. Restricted maximum likelihood method for random effect model and Mantel-Haenszel method for fixed effect model were used to estimate the effect size of new-onset AHREs, or SCAF detection in each group.
Studies comparing contemporary single- and dual-chamber ICD (VVI-/DDD-ICD) versus VDD-ICD were included. We comprehensively searched PubMed, Embase, and. This meta-analysis aims to evaluate the performance of atrial sensing dipole in single lead implantable cardioverter defibrillator (VDD-ICD) recipients in particular diagnosing new-onset atrial high-rate episodes (AHREs) defined as rate threshold of 200 beats per minute, or subclinical atrial fibrillation (SCAF) defined as device-detected AF without symptoms.
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