Inappropriate Defibrillator Therapies: Do Dual-chamber Devices Really Provide a Remedy?

Abstract

Inappropriate shock therapy from an implantable cardioverter defibrillator (ICD) is very painful for patients and may lead to a poor quality of life (QOL) and/or proarrhythmic effects. Excessively aggressive and specific programming of the ICD detection parameters with the aim of avoiding inappropriate therapy may result in a loss of its sensitivity (and in the worst case even to fatal underdetection of VF). Both sensitivity and specificity of the ICD’s diagnostic functions are expected to be improved by atrial sensing, which provides a more complex algorithm for arrhythmia detection based on both ventricular and atrial activity [1–3]. On the other hand, the addition of an atrial lead may produce several adverse effects, such as extension of the operating time, higher risk of lead dislodgement, cardiac tamponade, and occlusion of the subclavian vein.