Vol 24, No 6 (2017)
Original articles — Clinical cardiology
Published online: 2016-10-14

open access

Page views 1350
Article views/downloads 1482
Get Citation

Connect on Social Media

Connect on Social Media

Influence of echocardiographic and radiographic characteristics on atrial sensing amplitude in patients with Linox Smart S DX defibrillation leads

Marcin Michalak, Andrzej Cacko, Agnieszka Kapłon-Cieślicka, Monika Budnik, Przemysław Stolarz, Grzegorz Opolski, Marcin Grabowski
Pubmed: 27747856
Cardiol J 2017;24(6):671-676.


Background: Single-lead for implantable cardioverter-defibrillator (ICD) with floating atrial sensing dipole is a new diagnostic tool with the potential advantage in terms of arrhythmia discrimination. We sought to determine whether right heart size and dipole position influence atrial sensing. Methods: Atrial sensing (AS) amplitude was measured during implantation (PP, periprocedural), predischarge (IHFU, in-hospital follow-up) and 3–6 months after the procedure (AFU, ambulatory follow-up). Results were related to atrial dipole position in the right atrium (RA) on the basis of chest X-ray examination as well as right heart dimensions at echocardiography. Results: Twenty-four patients were included into final analysis. In 14 (58.3%) patients, sensing dipole was located in regions 1 and 2 of the RA. AS amplitude was greater in regions 1 and 2 when com¬pared to other locations (3.15 vs. 1.2 mV, p = 0.045, 7.53 vs. 3.8 mV, p < 0.001 and 5.63 vs. 2.44 mV, p = 0.017 for PP measurements, IHFU and AFU, respectively). There was a significant negative correlation between AS-PP and short RA dimension (RADs) (r = –0.56, p = 0.02), AS-IHFU and RA area (RAA) (r = –0.45, p < 0.05), AS-AFU and long RA dimension (RADl) (r = –0.46; p = 0.02), AS-AFU and RADs (r = –0,48, p = 0.02), and AS-AFU and RAA (and r = –0.52, p < 0.01). There was no relationship between AS and other right heart dimensions. Conclusions: Larger RA size and low sensing dipole location were associated with lower AS amplitude in single-lead dual chamber ICD.

Article available in PDF format

View PDF Download PDF file


  1. Carson P, Anand I, O'Connor C, et al. Mode of death in advanced heart failure: the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial. J Am Coll Cardiol. 2005; 46(12): 2329–2334.
  2. Pons F, Lupón J, Urrutia A, et al. Mortality and cause of death in patients with heart failure: findings at a specialist multidisciplinary heart failure unit. Rev Esp Cardiol. 2010; 63(3): 303–314.
  3. Priori S, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015; 36(41): 2793–2867.
  4. McMurray J, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012; 33(14): 1787–1847.
  5. Kotecha D, Piccini JP. Atrial fibrillation in heart failure: what should we do? Eur Heart J. 2015; 36(46): 3250–3257.
  6. Mamas MA, Caldwell JC, Chacko S, et al. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail. 2009; 11(7): 676–683.
  7. Kutyifa V, Daubert JP, Olshansky B, et al. Characterization and predictors of first and subsequent inappropriate ICD therapy by heart rate ranges: Result of the MADIT-RIT efficacy analysis. Heart Rhythm. 2015; 12(9): 2030–2037.
  8. Leenhardt A, Defaye P, Mouton E, et al. OPERA Registry Investigators. First inappropriate implantable cardioverter defibrillator therapy is often due to inaccurate device programming: analysis of the French OPERA registry. Europace. 2012; 14(10): 1465–1474.
  9. Berenbom LD, Weiford BC, Vacek JL, et al. Differences in outcomes between patients treated with single- versus dual-chamber implantable cardioverter defibrillators: a substudy of the Multicenter Automatic Defibrillator Implantation Trial II. Ann Noninvasive Electrocardiol. 2005; 10(4): 429–435.
  10. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005; 352(3): 225–237.
  11. Peterson PN, Varosy PD, Heidenreich PA, et al. Association of single- vs dual-chamber ICDs with mortality, readmissions, and complications among patients receiving an ICD for primary prevention. JAMA. 2013; 309(19): 2025–2034.
  12. Dewland TA, Pellegrini CN, Wang Y, et al. Dual-chamber implantable cardioverter-defibrillator selection is associated with increased complication rates and mortality among patients enrolled in the NCDR implantable cardioverter-defibrillator registry. J Am Coll Cardiol. 2011; 58(10): 1007–1013.
  13. Friedman PA, Bradley D, Koestler C, et al. A prospective randomized trial of single- or dual-chamber implantable cardioverter-defibrillators to minimize inappropriate shock risk in primary sudden cardiac death prevention. Europace. 2014; 16(10): 1460–1468.
  14. Almendral J, Arribas F, Wolpert C, et al. Dual-chamber defibrillators reduce clinically significant adverse events compared with single-chamber devices: results from the DATAS (Dual chamber and Atrial Tachyarrhythmias Adverse events Study) trial. Europace. 2008; 10(5): 528–535.
  15. Theuns DA, Rivero-Ayerza M, Boersma E, et al. Prevention of inappropriate therapy in implantable defibrillators: A meta-analysis of clinical trials comparing single-chamber and dual-chamber arrhythmia discrimination algorithms. Int J Cardiol. 2008; 125(3): 352–357.
  16. Sinha AM, Stellbrink C, Schuchert A, et al. Clinical experience with a new detection algorithm for differentiation of supraventricular from ventricular tachycardia in a dual-chamber defibrillator. J Cardiovasc Electrophysiol. 2004; 15(6): 646–652.
  17. Gold MR, Ahmad S, Browne K, et al. Prospective comparison of discrimination algorithms to prevent inappropriate ICD therapy: primary results of the Rhythm ID Going Head to Head Trial. Heart Rhythm. 2012; 9(3): 370–377.
  18. Glikson M, Swerdlow CD, Gurevitz OT, et al. Optimal combination of discriminators for differentiating ventricular from supraventricular tachycardia by dual-chamber defibrillators. J Cardiovasc Electrophysiol. 2005; 16(7): 732–739.
  19. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23(7): 685–713; quiz 786.
  20. LANG R, BIERIG M, DEVEREUX R, et al. Recommendations for chamber quantification☆. Eur J Echocardiogr. 2006; 7(2): 79–108.
  21. Iori M, Giacopelli D, Quartieri F, et al. Implantable cardioverter defibrillator system with floating atrial sensing dipole: a single-center experience. Pacing Clin Electrophysiol. 2014; 37(10): 1265–1273.
  22. Safak E, Schmitz D, Konorza T, et al. Linox DX Study Investigators. Clinical efficacy and safety of an implantable cardioverter-defibrillator lead with a floating atrial sensing dipole. Pacing Clin Electrophysiol. 2013; 36(8): 952–962.
  23. Healey J, Connolly S, Gold M, et al. Subclinical Atrial Fibrillation and the Risk of Stroke. New Engl J Med. 2012; 366(2): 120–129.
  24. Vaziri SM, Larson MG, Benjamin EJ, et al. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994; 89(2): 724–730.
  25. ASINGER R. Role of Transthoracic Echocardiography in Atrial Fibrillation. Echocardiography. 2000; 17(4): 357–364.
  26. Santini M, Ricci R, Pignalberi C, et al. Immediate and long-term atrial sensing stability in single-lead VDD pacing depends on right atrial dimensions. Europace. 2001; 3(4): 324–331.
  27. de Cock CC, Van Campen LC, Huygens J, et al. Usefulness of echocardiography to predict inappropriate atrial sensing in single-lead VDD pacing. Pacing Clin Electrophysiol. 1999; 22(9): 1344–1347.