The utilization of atrial sensing dipole in single lead implantable cardioverter defibrillator for detection of new‐onset atrial high‐rate episodes or subclinical atrial fibrillation: A systematic review and meta‐analysis

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. We comprehensively searched PubMed, Embase, and ClinicalTrials.gov. Studies comparing contemporary single‐ and dual‐chamber ICD (VVI‐/DDD‐ICD) versus VDD‐ICD 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. Three prospective studies were identified and total of 991 participants were included. There were 330 (33.3%) in VDD‐ICD and 661 (66.7%) in VVI‐/DDD‐ICD. Most (78%) participants were men. Median follow‐up was from 365 days to 847 days. VDD‐ICD has a higher likelihood of detecting AHREs or SCAF as compared to VVI‐/DDD‐ICD [(OR random effect : 2.6; 95% CI: 1.2, 5.8; p = .018); I‐squared = 67.8%, p = .019]. This difference was more apparently seen in the comparison between VDD‐ICD and VVI‐ICD [(OR random effect: 3.8; 95% CI: 2.1, 6.6, p < .001), I‐squared = 0.0%, p = .518]. The result is same as fixed effect. Rate of AHREs detection observed in VDD‐ICD was not statistically different when compared to the only group with DDD‐ICD from SENSE trial. 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.