During our DX symposium at EHRA 2021, renowned cardiac rhythm specialists presented key clinical studies on DX technology and discussed whether we still need an atrial lead for atrial sensing in ICD patients.
Watch the full recording here, and feel free to contact us if you want to learn more.
True Atrial Signal. No Atrial Lead.
DR Smart. VR Simple. CRT Capable
DX Technology is a unique hybrid system combining the advantages of both single- and dual-chamber ICD systems. It offers AF detection, 3-channel IEGMs, SVT discrimination, and A-V sequential pacing like a dual-chamber system, while making procedures less complex and allowing for lower implant complication rates.
Atrial signals can be reliably sensed by the floating dipole rings located in the proximal part of the DX lead, thanks to a special atrial input stage of the DX device.1,2
Atrial sensing allows the SMART Detection algorithm to discriminate supraventricular tachycardias (SVTs) from ventricular tachycardias (VTs) by analyzing atrial and ventricular rhythms, an exclusive feature previously available only in dual-chamber ICDs.3
Better and earlier AT/AF detection leads to improved patient care.4 Like this, BIOTRONIK DX systems provide unique protection to ICD patients who do not require atrial pacing.
For this patient group, DX Technology also extends these advantages to cardiac resynchronization therapy, as CRT-DX provides equivalent therapy with less hardware.5
Dr. George Thomas, Principal Investigator of the SENSE Study, on DX Technology and AHRE Detection.
Dr. Chris Liu of Weill Cornell Medical College, New York, NY, on Dual-Lead Equivalency and Single-Lead Simplicity with DX Technology.
Dr. George Thomas, Principal Investigator of the SENSE Study, on Inappropriate Therapies for Ventricular Arrythmias with DX Technology.
DX Technology is Superior to Single-Chamber and Comparable with Dual-Chamber in Detecting Atrial High-Rate Episodes (AHRE) …
The SENSE study showed that the AHRE detection rate6 was significantly higher in the DX cohort compared to the single-chamber cohort (p=0.026).7 While AHRE detection was not significantly different from the dual-chamber cohort (p=1.00),8 multivariate regression showed that the use of DX was associated with AHRE detection.9
… and Shows Stable and Reliable Atrial Sensing
Mean sensed atrial amplitude
Mean sensed atrial amplitude
at 12-month follow-up11
Additional results from the THINGS registry showed that almost all patients had appropriate atrial signal detection at 2-year follow-up.12
The Incidence of AT/AF Diagnosis is Significantly Higher with DX Technology Compared to Single-Chamber ICDs ...
Results from the THINGS registry also show that DX systems are associated with an almost 4-fold likelihood of detecting AT/AF compared to conventional devices.13
…Leading to a Trend of Increased Onset of Oral Anticoagulation.14
CRT-DX Extends the Advantages of DX Technology also to Cardiac Resynchronization Therapy, Allowing for a Significantly Lower Rate of Major Complications…
The QP ExCELs registry has shown that with CRT-DX, there were significantly fewer patients who experienced major complications.15
…While Achieving Similar CRT Responses in LV Pacing and Clinical Outcome Parameters.
There were no significant differences in median LV pacing between groups.16
Clinical outcomes in the two groups were similar.17
All values represent percentage of patients.
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1 Safak E et al. Clinical efficacy and safety of an implantable cardioverter-defibrillator lead with a floating atrial sensing dipole. Pacing Clin Electrophysiol. 2013; 36: 952-62.
2 Iori M et al. Implantable cardioverter defibrillator system with floating atrial sensing dipole: a single-center experience. Pacing Clin Electrophysiol. 2014; 37(10):1265-73.
3 Sinha et al. Discrimination of VT and SVTs with a new detection algorithm in a dual-chamber ICD. Herzschrittmacher. 2000; 20(3): 208-14.
4 Thomas G et al. Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter‐defibrillator systems: Results of the SENSE trial. J Cardiovasc Electrophysiol. 2019; 30: 1994‐ 2001.
5 Biffi M et al. Less is more: Can we achieve cardiac resynchronization with 2 leads only? Int J Cardiol. 2017; 249:184-190.
6 AHREs were defined as atrial tachyarrhythmias with atrial rate greater than 200 bpm lasting for > 30 seconds.
7-11 Thomas G et al. Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter‐defibrillator systems: Results of the SENSE trial. J Cardiovasc Electrophysiol. 2019; 30: 1994‐ 2001. 1
9 adjusted HR 2.40; 1.05-5.48; p = 0.038
10-11 Mean sensed atrial amplitude was 8.0 ± 5.0 mV at implant and 7.3 ± 4.8 mV at 12-month follow-up.
12 Biffi M- et al. The role of atrial sensing for new-onset atrial arrhythmias diagnosis and management in single-chamber implantable cardioverter-defibrillator recipients: Results from the THINGS registry. J Cardiovasc Electrophysiol. 2020; 31: 846– 853.
14 Biffi M et al. The role of atrial sensing for new-onset atrial arrhythmias diagnosis and management in single-chamber implantable cardioverter-defibrillator recipients: Results from the THINGS registry. J Cardiovasc Electrophysiol. 2020; 31: 846– 853.
15-17 Shaik, NA et al. Novel two‐lead cardiac resynchronization therapy system provides equivalent CRT responses with less complications than a conventional three‐lead system: Results from the QP ExCELs lead registry. J Cardiovasc Electrophysiol. 2020; 31: 1784– 1792.2