Implantable atrial defibrillator and detection of atrial flutter

The implantable atrial defibrillator (IAD) is designed to detect and treat atrial fibrillation (AF) with low energy synchronized shocks. A patient wit h a history of persistent AF was implanted with an IAD after ineffective tr eatment with procainamide and sotalol. Through four months of follow-up, th e IAD performed appropriate detection and treatment of AF. During the fifth month, the patient was put on flecainide in an attempt to minimize the AF recurrence rate. On flecainide the patient experienced typical atrial flutt er which required IAD reprogramming for appropriate detection and therapy d elivery. This case report examines the optimization of the IAD to detect at rial flutter. Six months of follow-up after optimization the IAD has shown appropriate detection of both atrial flutter and AF, During the entire foll ow-up period the IAD had appropriate detection of sinus rhythm (no false po sitive detection, i.e. sinus rhythm as AF).