Key result
Baseline atrial sensing amplitude >1.5 mV during sinus rhythm was associated with a lower risk of 24-hour atrial high-rate episodes compared to ≤1.5 mV (HR 0.52; 95% CI 0.33-0.83; P=0.006).
Why the study?
Parameters measured during ICD implant depend on myocardial bioelectrical properties, prompting investigation into their potential association with clinical outcomes in patients with single/dual-chamber ICD and CRT-D.
Do baseline electrical parameters measured during ICD/CRT-D implant predict clinical outcomes such as mortality, ventricular arrhythmias, and atrial high-rate episodes?
Cohort (n=2,976)
Yes
Do baseline electrical parameters measured during ICD/CRT-D implant predict clinical outcomes such as mortality, ventricular arrhythmias, and atrial high-rate episodes?
Hazard Ratio: 0.52 (95% CI 0.33–0.83)
p-value: p=0.006
Low baseline sinus rhythm atrial sensing amplitude (≤1.5 mV) measured during ICD/CRT-D implantation is an independent predictor of future atrial high-rate episodes.
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.
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Zecchin et al. (2020) conducted a cohort in Patients with single/dual-chamber ICD and CRT-D (n=2,976). Baseline atrial sensing amplitude >1.5 mV vs. Baseline atrial sensing amplitude ≤1.5 mV was evaluated on Atrial high-rate episode lasting ≥24 hours (24 h AHRE) (HR 0.52, 95% CI 0.33-0.83, p=0.006). Baseline atrial sensing amplitude >1.5 mV during sinus rhythm was associated with a lower risk of 24-hour atrial high-rate episodes compared to ≤1.5 mV (HR 0.52; 95% CI 0.33-0.83; P=0.006).
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