Atrial Fibrillation in Patients with a Dual Defibrillator: Characteristics of Spontaneous and Induced Episodes and Effect of Ventricular Tachyarrhythmia Induction

Boriani, Giuseppe; Raviele, Antonio; Biffi, Mauro; Gasparini, G.; Martignani, Cristian; Valzania, Cinzia; Diemberger, Igor; Corrado, Andrea; Raciti, Giovanni; Branzi, Angelo

doi:10.1111/j.1540-8167.2005.50009.x

Cited by 3 publications

(11 citation statements)

References 39 publications

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“…As in ventricular defibrillation, biphasic shocks are standard, but tolerability still requires improvement. Further reductions in the atrial defibrillation threshold could be achieved by improving lead configuration 22,24,25,47–49 . One possibility that has already been tested in clinical practice is implantation of a dedicated lead in the coronary sinus (Fig.…”

Section: The Issue Of Shock‐induced Discomfortmentioning

confidence: 99%

“…Drugs could help prevent early recurrences of AF after effective shock termination 11,69 Pharmacological enhancement of ATP might improve the likelihood of painless device‐based termination of arrhythmia 25,72 The protection against proarrhythmias provided by multi‐chamber devices equipped with atrial defibrillator capability could encourage acute oral loading of antiarrhythmic drugs on recurrence of AF 73–75 .…”

Section: How Might Device‐based Atrial Defibrillation Find a New Rolementioning

confidence: 99%

“…Pharmacological enhancement of ATP might improve the likelihood of painless device‐based termination of arrhythmia 25,72 …”

Section: How Might Device‐based Atrial Defibrillation Find a New Rolementioning

confidence: 99%

“…6,10,11,21 This allowed implementation of "tiered therapy"-a sequential approach starting with painless interventions and working up to high-energy shocks, as required. These dualchamber devices can deliver high-energy shocks either with the conventional configurations used for ventricular tachyarrhythmias, or else in dedicated, atrial-specific configurations requiring a coronary sinus lead [22][23][24][25] (Fig. 1).…”

Section: Dual-chamber Atrial Defibrillatorsmentioning

confidence: 99%

“…Further reductions in the atrial defibrillation threshold could be achieved by improving lead configuration. 22,24,25,[47][48][49] One possibility that has already been tested in clinical practice is implantation of a dedicated lead in the coronary sinus ( Fig. 1).…”

Section: The Issue Of Shock-induced Discomfortmentioning

confidence: 99%

See 4 more Smart Citations

How, Why, and When May Atrial Defibrillation Find a Specific Role in Implantable Devices? A Clinical Viewpoint

Boriani¹,

Diemberger²,

Biffi³

et al. 2007

Pacing Clinical Electrophis

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This viewpoint article discusses the potential for incorporation of atrial defibrillation capabilities in modern multi-chamber devices. In the late 1990s, the possibility of using shock-only therapy to treat selected patients with recurrent atrial fibrillation (AF) was explored in the context of the stand-alone atrial defibrillator. The failure of this strategy can be attributed to the technical limitations of the stand-alone device, low tolerance of atrial shocks, difficulties in patient selection, a lack of predictive knowledge about the evolution of AF, and, last but not least, commercial considerations. An open question is how atrial defibrillation capability may now assume a specific new role in devices implanted for sudden death prevention or cardiac resynchronization. For patients who already have indications for implantable devices, device-based atrial defibrillation appears attractive as a "backup" option for managing AF when preventive pharmacological/electrical measures fail. This and several other personalized hybrid therapeutic approaches await exploration, though assessment of their efficacy is methodologically challenging. Achievement of acceptance by patients is an essential premise for any updated atrial defibrillation strategy. Strategies that are being investigated to improve patient tolerance include waveform shaping, pharmacologic modulation of pain, and patient-activated defibrillation (patients might also perceive the problem of discomfort somewhat differently in the context of a backup therapy). The economic impact of implementing atrial defibrillation features in available devices is progressively decreasing, and financial feasibility need not be a major issue. Future studies should examine clinically relevant outcomes and not be limited (as occurred with stand-alone defibrillators) to technical or other soft endpoints.

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Section: The Issue Of Shock‐induced Discomfortmentioning

confidence: 99%

Section: How Might Device‐based Atrial Defibrillation Find a New Rolementioning

confidence: 99%

“…Pharmacological enhancement of ATP might improve the likelihood of painless device‐based termination of arrhythmia 25,72 …”

Section: How Might Device‐based Atrial Defibrillation Find a New Rolementioning

confidence: 99%

Section: Dual-chamber Atrial Defibrillatorsmentioning

confidence: 99%

Section: The Issue Of Shock-induced Discomfortmentioning

confidence: 99%

See 3 more Smart Citations

How, Why, and When May Atrial Defibrillation Find a Specific Role in Implantable Devices? A Clinical Viewpoint

Boriani¹,

Diemberger²,

Biffi³

et al. 2007

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

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Painless Shock Therapy: More Than Just an Attempt to Square the Circle?

Boriani

Biffi

Martignani

2007

Cardiovasc electrophysiol

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Obstructive Sleep Apnea as a Predictor of Inducible Atrial Flutter During Pulmonary Vein Isolation in Patients With Atrial Fibrillation: Clinical Significance and Follow-Up Outcomes

Taylor

Assaf

et al. 2023

Cardiol Res

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Background Atrial fibrillation (AF) and atrial flutter (AFL) often coexist in patients and may lead to severe symptoms and complications. Despite their coexistence, prophylactic cavotricuspid isthmus (CTI) ablation has failed to reduce the incidence of recurrent AF or new onset AFL. In contrast, the presence of inducible AFL during pulmonary vein isolation (PVI) has been shown to be predictive of symptomatic AFL during follow-up. However, the potential role of obstructive sleep apnea (OSA) as a predictor of inducible AFL during PVI in patients with AF remains unclear. Therefore, this study aimed to examine the potential role of OSA as a predictor of inducible AFL during PVI in patients with AF and reexamine the clinical significance of inducible AFL during PVI in terms of recurrent AFL or AF during follow-up. Methods We conducted a single-center, non-randomized retrospective study on patients who underwent PVI between October 2013 and December 2020. A total of 192 patients were included in the study after screening 257 patients for exclusion criteria, which included a previous history of AFL or previous PVI or Maze procedure. All patients underwent a transesophageal echocardiogram (TEE) prior to their ablation to rule out a left atrial appendage thrombus. The PVI was performed using both fluoroscopic and electroanatomic mapping derived from intracardiac echocardiography. After the confirmation of PVI, additional electrophysiology (EP) testing was performed. AFL was classified as typical or atypical based on the origin and activation pattern. Descriptive and frequency statistics were performed to describe the demographic and clinical characteristics of the sample, and Chi-square and Fisher’s exact tests were used to compare independent groups on categorical outcomes. Logistic regression analysis was performed to adjust for confounding variables. The study was approved by the Institutional Review Board, and informed consent was waived given the retrospective nature of the study. Results Of the 192 patients included in the study, 52% (n = 100) had inducible AFL after PVI, with 43% (n = 82) having typical right AFL. Bivariate analysis showed statistically significant differences between the groups for OSA (P = 0.04) and persistent AF (P = 0.047) when examining the outcome of any inducible AFL. Similarly, only OSA (P = 0.04) and persistent AF (P = 0.043) were significant when examining the outcome of typical right AFL. Multivariate analysis showed that only OSA was significantly associated with any inducible AFL after controlling for other variables (adjusted odds ratio (AOR) = 1.92, 95% confidence interval (CI): 1.003 - 3.69, P = 0.049). Of the 100 patients with inducible AFL, 89 underwent additional ablation for AFL prior to completion of their procedure. At 1 year, the rates of recurrence for AF, AFL, and either AF or AFL were 31%, 10%, and 38%, respectively. There was no significant difference in the rates of recurrence of AF, AFL, or eit...

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Atrial Fibrillation in Patients with a Dual Defibrillator: Characteristics of Spontaneous and Induced Episodes and Effect of Ventricular Tachyarrhythmia Induction

Cited by 3 publications

References 39 publications

How, Why, and When May Atrial Defibrillation Find a Specific Role in Implantable Devices? A Clinical Viewpoint

How, Why, and When May Atrial Defibrillation Find a Specific Role in Implantable Devices? A Clinical Viewpoint

Painless Shock Therapy: More Than Just an Attempt to Square the Circle?

Obstructive Sleep Apnea as a Predictor of Inducible Atrial Flutter During Pulmonary Vein Isolation in Patients With Atrial Fibrillation: Clinical Significance and Follow-Up Outcomes

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