Ein neues Konzept zur Behandlung von supraventrikulären Tachykardien nach Herzoperationen: Niederenergetische interne Kardioversion über eine temporäre atriale Elektrode

Abstract

Supraventricular tachycardia (SVT) is a common complication early after cardiac surgery. A novel temporary atrial patch electrode (TAPE) for low energy atrial defibrillation was first implanted for intraoperative testing and subsequently removed during open heart surgery in 10 patients (Phase I). After the intraoperative testing period, the TAPE was implanted in 20 patients for postoperative termination of spontaneous episodes of supraventricular tachycardia (Phase II). In case of supraventricular tachycardia (SVT), biphasic shocks (1.2-5.0 J) were applied, measuring the atrial defibrillation thresholds. Phase I: The mean intraoperative atrial defibrillation threshold was 1.6 +/- 1.4 J with a mean shock-impedance of 64.0 +/- 7.3 Ohms. Phase II: Postoperatively, 6 out of 20 patients (30%) developed 7 episodes of atrial fibrillation (n = 6) and atrial flutter (n = 1). In 5 patients, SVT could be converted to sinus rhythm (n = 5) or junctional rhythm (n = 1). The mean postoperative defibrillation threshold (DFT) was 2.7 +/- 2.1 J with a mean shock-impedance of 50.2 +/- 6.8 Ohms. In conclusion, the TAPE allows low-energy defibrillation of atrial fibrillation. It seems to be a useful alternative in the treatment of supraventricular tachycardia.