Clinical utility of the atrioventricular, single-lead defibrillator systems with a floating atrial dipole (DX ICD): an executive summary
Németh Marianna1, Zima Endre1, Duray Gábor Zoltán2, Balázs Tibor3, Vámos Máté4
1Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
2Magyar Honvédség Egészségügyi Központ, Kardiológia Osztály, Budapest
3Biotronik Hungária Kft., Budapest
4Szegedi Tudományegyetem, ÁOK, Belgyógyászati Klinika, Szeged
Implantable cardioverter defibrillators offer preeminent therapeutic option for the prevention of sudden cardiac death. Beyond the treatment of malignant arrhythmias, ICDs can be expanded with additional functions to further improve morbidity and mortality of patients suffering from arrhythmias and heart failure. It is well known that the increase in the number of electrodes directly increases the risk of complications. The single-lead ICD system with a floating atrial dipole (DX ICD) preserves atrial sensing without the need to implant an additional lead. All advantages of the system are based on reliable and stable atrial sensing. In the current generation of DX devices, the specially filtered atrial signal seems to be high enough and stable over time. This feature is crucial in the early detection of atrial arrhythmias and in a correct discrimination between different forms of tachycardia’s to prevent inappropriate ICD therapy, furthermore, in achieving an optimal atrioventricular and interventricular synchrony in patients with a two-lead CRT-DX system.
A detailed review was recently published by the authors of the current paper in a prestigious international journal summarizing the clinical advantages and potential disadvantages of DX ICD technology based on the available literature. This time we summarized the most important conclusions of the cited study, the domestic aspects and the proposed, evidence-based algorithm of proper ICD selection for the Hungarian physicians.