Clinical efficacy and safety of atrial defibrillation using biphasic shocks and current nonthoracotomy endocardial lead configurations

Saksena, Sanjeev; Prakash, Atul; Mangeon, Luc; Varanasi, Sankar; Kolettis, Theofilos M.; Mathew, Philip; Groot, Paul de; Mehra, Rahul; Król, Ryszard B.

doi:10.1016/s0002-9149(99)80261-6

Cited by 86 publications

(37 citation statements)

References 14 publications

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“…16,17) It is reported that the atrial fibrillation threshold in terms of mean energy varies from as low as 1.5 to as high as 8.9 using biphasic shocks with intracardiac defibrillation. 12,13) The internal cardiac defibrillation threshold is not influenced by the chest configuration and body mass and more precisely ascertains the factors directly related to the electrophysiological and structural atrial substrate. 18) On basal ECG, fine fibrillatory activity which suggests the higher number of multiple reentrant circuits in the atria was found in 13 patients (86%).…”

Section: Discussionmentioning

confidence: 99%

“…11) In addition, atrial fibrillation thresholds determined from defibrillation electrodes placed in the high right atrium and the coronary sinus in terms of mean energy have varied from as low as 1.5 to as high as 8.9 using biphasic shocks. 12,13) For this reason, external shock that fails to reach the atrial defibrillation threshold might be one of the reasons for the unsuccessful cardioversion. We hypothesized that applying high energy shock waves to the chest may overcome the inadequate penetration by the electrical shock to the atrium.…”

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confidence: 99%

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Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

et al. 2004

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SUMMARYAtrial fibrillation (AF) has been treated with DC shocks delivered transthoracically, but in 5-30% of patients, the procedures fail to restore sinus rhythm (SR). We hypothesized that applying high energy shock waves to the chest may overcome the inadequate penetration of electrical shock to the atrium. The aim of this study was to evaluate the efficacy of higher energy external DC shock for the treatment of refractory AF coexisting with cardiovascular disease using a synchronized double external defibrillator.Fifteen patients (mean age 65 ± 8) with refractory AF to standard DC cardioversion (CV) underwent higher energy DC shock using a double external defibrillator. Concomitant heart disease was present in all patients. Warfarin and amiodarone (600 mg/day), were administered for at least three weeks duration before DC CV. Sedation was performed with IV midazolam. Two defibrillator paddles were positioned on the anterior and posterior chest wall in a right lateral decubitus position. Defibrillators were synchronized to the R waves and simultaneously 720 joules of energy was administered to the patients. Amiodarone (200 mg/day) was continuously administered after DC shock to maintain SR.Sinus rhythm was obtained in 13 patients. Sinus rhythm was persistent in 11 patients for six months duration. Creatine kinase MB fractions were normal at 4 (22 ± 4 IU/L) and 12 hours (18 ± 4 IU/L). None of the patients developed significant hemodynamic compromise or congestive heart failure, higher AV block, stroke, or transient ischemic cerebral events.The results indicate that higher energy DC shock application using a double external defibrillator is an effective and safe method for the cardioversion of refractory AF. We believe this procedure should be performed before internal atrial cardioversion. (Jpn Heart J 2004; 45: 929-936)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

et al. 2004

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“…22,23 This is the most common configuration for in-hospital internal cardioversion and is the standard config- uration used by the first stand-alone implantable atrial defibrillator. 7 With this RAA3 CS configuration, ADFTs in humans without a significant history of AF are 1.5 to 2.5 J and are significantly greater in patients with chronic AF.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Atrial Defibrillation Threshold With an Interatrial Septal Electrode

et al. 2000

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Background-The standard lead configuration for internal atrial defibrillation consists of a shock between electrodes in the right atrial appendage (RAA) and coronary sinus (CS). We tested the hypothesis that the atrial defibrillation threshold (ADFT) of this RAA3 CS configuration would be lowered with use of an additional electrode at the atrial septum (SP). Methods and Results-Sustained atrial fibrillation was induced in 8 closed-chest sheep with burst pacing and continuous pericardial infusion of acetyl-␤-methylcholine. Defibrillation electrodes were situated in the RAA, CS, pulmonary artery (PA), low right atrium (LRA), and across the SP. ADFTs of RAA3 CS and 4 other lead configurations were determined in random order by use of a multiple-reversal protocol. Biphasic waveforms of 3/1-ms duration were used for all single and sequential shocks. The ADFT delivered energies for the single-shock configurations were 1.27Ϯ0.67 J for RAA3 CS and 0.86Ϯ0.59 J for RAAϩCS3 SP; the ADFTs for the sequential-shock configurations were 0.39Ϯ0.18 J for RAA3 SP/CS3 SP, 1.16Ϯ0.72 J for CS3 SP/RAA3 SP, and 0.68Ϯ0.46 J for RAA3 CS/LRA3 PA. Except for CS3 SP/RAA3 SP versus RAA3 CS and RAA3 CS/LRA3 PA versus RAAϩCS3 SP, the ADFT delivered energies of all of the configurations were significantly different from each other (PϽ0.05). Conclusions-The ADFT of the standard RAA3 CS configuration is markedly reduced with an additional electrode at the

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“…The use of an implantable atrial defibrillator system to deliver low-energy shocks between special catheter electrodes permanently placed in the right atrium and coronary sinus has been under systematic study for many years, first in experimental models and more recently in patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] It is clear that the device can be used successfully to defibrillate the atria in most patients with paroxysmal or persistent atrial fibrillation. It is also clear that if the shock is synchronized to ventricular activation so that it is not delivered during the T wave of the preceding QRS complex, something that the device has been reliably programmed to do, the shock can be delivered safely.…”

Section: See P 883mentioning

confidence: 99%

“…[1][2][3][4] We have also known that synchronized delivery of a low-energy DC shock for cardioversion of atrial fibrillation is very effective. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] With the presentation by Liebold et al 22 of the study of 100 consecutive patients undergoing open heart surgery, we now have the demonstration of a new clinical application of both the use of temporary epicardial atrial wire electrodes and low-energy DC cardioversion of atrial fibrillation. The article by Liebold et al 22 is actually about 2 things.…”

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Low-Energy Atrial Defibrillation

Waldo

1998

Circulation

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T emporary epicardial wire electrodes placed during open heart surgery for potential diagnostic and/or therapeutic use in patients in the immediate postoperative period have been used safely and effectively as part of standard care for a long time. [1][2][3][4] We have also known that synchronized delivery of a low-energy DC shock for cardioversion of atrial fibrillation is very effective. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] With the presentation by Liebold et al 22 of the study of 100 consecutive patients undergoing open heart surgery, we now have the demonstration of a new clinical application of both the use of temporary epicardial atrial wire electrodes and low-energy DC cardioversion of atrial fibrillation. The article by Liebold et al 22 is actually about 2 things. One is a new therapeutic modality in the treatment of atrial fibrillation in the period immediately after open heart surgery. The other is the efficacy, safety, and tolerance of so-called low-energy atrial defibrillation. See p 883It is widely recognized that atrial fibrillation is a common and important problem in patients who have had open heart surgery. As recently summarized, 23 many studies have examined its potential cause(s), prevention, and treatment. Unfortunately, although these studies have provided some insights, the problem has abated little. Thus, according to the study by Liebold et al, 22 the demonstration of a new, effective treatment, low-energy atrial defibrillation with temporary epicardial wire electrodes placed on each atrium, is most welcome. The technique, initially studied in an animal model, 12,16 also permits standard use of epicardial wire electrodes for recording (diagnostic) and pacing (therapeutic and diagnostic) purposes, just as the traditional temporary epicardial atrial wire electrodes have been used in the past.1-4 Nevertheless, use of this technique does not change the problem, which is frequency of postoperative atrial fibrillation. Rather, it offers a much easier way to provide DC cardioversion of atrial fibrillation, when indicated, than the traditional delivery of a transthoracic DC shock. Early or late recurrence of atrial fibrillation notwithstanding, the technique of low-energy atrial defibrillation with temporary epicardial atrial wire electrodes should find a place in the standard treatment regimen for atrial fibrillation after open heart surgery.Perhaps the more important implications of the study by Liebold et al 22 pertain to the use of low-energy DC cardioversion of atrial fibrillation with the implantable atrial defibrillator. The use of an implantable atrial defibrillator system to deliver low-energy shocks between special catheter electrodes permanently placed in the right atrium and coronary sinus has been under systematic study for many years, first in experimental models and more recently in patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] It is clear that the device can be used successfully to defibrillate the atria in most patients with...

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Clinical efficacy and safety of atrial defibrillation using biphasic shocks and current nonthoracotomy endocardial lead configurations

Cited by 86 publications

References 14 publications

Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

Reduction of Atrial Defibrillation Threshold With an Interatrial Septal Electrode

Low-Energy Atrial Defibrillation

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