VIEW AN ABSTRACT

Introduction: Majority of patients with ICD and all with biventricular (biv) devices suffer from structural heart disease. Incidence of atrial fibrillation (AF) in this population is very high. High percentage of episodes is without symptoms. Rapid ventricular response in patients with ICD can cause repetitive charging and inappropriate shocks, in patients with biv devices it competes with biv pacing. The therapy of AF is much easier when early diagnosed. Home Monitoring (HM) is now available for ICD and biventricular pacemakers (PM) and can help in early diagnostics.
Case study 1: 62 year old man with ICD Lexos DR-T. In Oct 2005 repetitive messaging of ventricular tachycardia (VT) and ventricular fibrillation (VF) detection. Antitachycardia pacing and shocks emitted. Patients invited to follow-up (FU), AF with rapid ventricular response (RVR) diagnosed. After unsuccessful pharmacology and cardioversion treatment, nonselective ablation of AV node performed.
Case study 2: 69 year old man with biv PM Stratos LV-T almost daily sending messages of high number of ventricular extrasystoli. In Aug 2006 alerts “PM tachycardia detected” and “decrease in % of resynchronization therapy” (% CRT). Newly high percentage of intrinsic atrial and ventricular events in “AV conduction histogram” found. Suspected AF confirmed at FU.
Case study 3: 69 year old man with biv ICD Lumos VR-T. On Feb 6, 2007 sent repetitive messages about VF detection with therapy withdrawal and several with “30J shock unsuccessful” and VT detection. AF with RVR and non-sustained VTs diagnosed. Amiodarone introduced.
Conclusion: AF diagnostics in HM is dependent on “complications” such as rapid ventricular response leading to VT/VF detection in ICD or decrease in % CRT in biv devices. We detected AF also after false repetitive messaging of PM tachycardia.
Supported by grant MSMT-MSM 0021622402