INDICO AF - Atrial Fibrillation in patients with an implantable cardioverter defibrillator and coronary artery disease.

Coronary artery disease (CAD) patients with reduced left ventricular ejection
fraction (LVEF) are indicated for Implantable Cardioverter Defibrillator (ICD)
therapy as prevention for sudden cardiac death (SCD). Timely detection of
atrial fibrillation (AF) in ICD patients is clinically important for
appropriate treatment for prevention of AF related complications such as stroke
and inappropriate ICD shocks. Patients with a two- or three chamber ICD and CAD
show a higher incidence of  AF. If CAD patients with a single chamber ICD carry
a similar risk for AF remains unknown. Recently, single chamber ICDs including
algorithm based rhythm recorders are developed  to investigate the incidence
and prevalence of AF.

To investigate the incidence of new-onset  AF in patients with CAD and a single
chamber ICD.

This study will be a multicentre observational study. Patients with CAD, 35% and no history of AF will receive an single chamber ICD including an
algorithm based rhythm recorder. In combination with remote monitoring data
will be collected every month during 1 year or until an event rate of 20%.
Blood drawing and a twelve lead ECG will be made on the day of implantation and
during 6 and 12 months follow up, during standard ICD interoggation. All
patients in whom AF is documented will be invited for an outpatient visit and
will receive adequate anticoagulation treatment, when appropriate according to
CHADSVASc score.

The risk of AF in a population of patients with CAD and a reduced LVEF is high,
but the available data are derived from patients wit a two- or three chamber
ICD. It is likely that patients with CAD and a reduced LVEF recieving a single
chamber ICD for prevention of SCD carry a similar high risk for AF. Particpants
will recieve a single chamber ICD including an alghorythm based rhythm recorder
for the detection of AF. In order to detect AF, patients are asked to use the
patient unit once a month to send the stored data to the AMC. Follow-up of
patients will be performed in one of the participating centers at 6 and 12
months and every six months during standard ICD interrogation untill we reach
an event rate of 20%. .Participants will have potential benefit through the
early detection of AF and start of oral anticoagulation therapy.