REACT DX registry: Real world REACTion to atrial high rate episodes detected in implantable cardioverter-defibrillator recipients with a DX lead

Article type: Research Article

Authors: O’Connor, Matthew^{a; b} | Kolb, Christof^a | Klein, Norbert^c | Rauwolf, Thomas^d | Kuster, Stefan^e | Kääb, Stefan^{f; 1} | Tilz, Roland Richard^{g; m} | Bänsch, Dietmar^h | Ince, Hüseyinⁱ | Belke, Roberto^{j; 1} | Hauser, Tino^j | Rietsch, Katrin^j | Krämer, Jan F.^k | Wessel, Niels^{k; 1} | Lennerz, Carsten^{a; l; *}

Affiliations: [a] German Heart Center Munich, Department of Electrophysiology, Technical University of Munich, Munich, Germany | [b] The Royal Brompton and Harefield NHS Trust, Department of Electrophysiology, London, UK | [c] Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH, Leipzig, Germany | [d] Internal Medicine/Cardiology and Angiology, Magdeburg University, Magdeburg, Germany | [e] Department of Internal Medicine, Cardiology, DRK Hospital Mölln-Ratzeburg, Ratzeburg, Germany | [f] Department of Medicine 1, University Hospital, LMU Munich, Munich, Germany | [g] University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein (UKSH), Lübeck, Germany | [h] Clinic for Electrophysiology, KMG Klinikum, Güstrow, Germany | [i] Department of Cardiology, Rostock University Medical Center, Rostock, Germany | [j] BIOTRONIK, Berlin, Germany | [k] Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany | [l] German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany | [m] German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany

Correspondence: [*] Corresponding author: Carsten Lennerz, Deutsches Herzzentrum München, Lazarettstr. 36, 80636 München, Germany. E-mail: lennerz@dhm.mhn.de.

Note: [1] Steering Committee REACT DX Registry.

Abstract: BACKGROUND: Atrial fibrillation (AF) is associated with significant morbidity and is predicted by atrial high rate events. The early detection of AF is paramount to timely interventions to reduce the morbidity of AF. The DX ICD system combined with Home Monitoring® allows for continuous atrial rhythm monitoring without the need for a dedicated atrial lead. OBJECTIVE: To establish the reaction to and timing of reactions to the detection of atrial high rate episodes (AHRE). METHODS: A prospective cohort of DX ICD systems was followed up and the response to AHREs was collected and evaluated. RESULTS: A total of 234 patients were enrolled; an AHRE ⩾ 6 min was detected in 13.7% of patients (n= 32) within a mean follow-up duration of 16 months. A high rate of oral anticoagulation (OAC) prescription was seen with the detection of AHREs in patients with a not-low risk CHA2DS2-VASc score. There was a delay in this prescription highlighting the potential to improve the timeliness of patient care in this group of patients. CONCLUSIONS: The DX ICD system provides rapid and ongoing atrial rhythm monitoring such that physicians are rapidly aware of AHRE without the need for a dedicated atrial lead, but local protocols are needed to improve the response time of anti-coagulation prescription.

Keywords: DX technology, home monitoring, atrial high rate events, atrial fibrillation, oral anticoagulation

DOI: 10.3233/THC-220432

Journal: Technology and Health Care, vol. 31, no. 2, pp. 735-746, 2023