A medical device is provided that comprises a lead assembly. The lead assembly includes at least one intra-cardiac (IC) electrode, an extra-cardiac (EC) electrode and a subcutaneous remote-cardiac (RC) electrode. The IC electrode is configured to be located within the heart. The EC electrode is configured to be positioned proximate to at least one of a superior vena cava (SVC) and a left ventricle (LV) of a heart. The RC electrode is configured to be located remote from the heart. An arrhythmia monitoring module is configured to analyze intra-cardiac electrogram (IEGM) signals from the at least one IC electrode to identify a potential atrial arrhythmia. An extra-cardiac impedance (ECI) module is configured to measure extra-cardiac impedance along an ECI vector between the EC and RC electrodes to obtain ECI measurements. The hemodynamic performance (HDP) assessment module is configured to determine a hemodynamic performance based on the ECI measurements. The arrhythmia monitoring module is configured to declare the potential atrial arrhythmia to be an atrial arrhythmia based on the hemodynamic performance determined from the ECI measurements. The medical device further provides the HDP assessment module that derives a current ECI waveform from current ECI measurements and compares the current ECI pattern with a prior ECI waveform that is derived from prior ECI measurements.
