Safety and efficacy of advanced atrial pacing therapies for atrial tachyarrhythmias in patients with a new implantable dual chamber cardioverter-defibrillator

Gillis, Anne M.; Unterberg‐Buchwald, Christina; Schmidinger, Herwig; Santini, Massimo; Wolfe, Kevin; Kavaney, Deborah J; Otterness, Mary F.; Hohnloser, Stefan H.; Investigators, Gem Iii At Worldwide

doi:10.1016/s0735-1097(02)02345-8

Cited by 77 publications

(52 citation statements)

References 18 publications

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“…If ventricular rate falls within the VF detection window, appropriate therapy should not be withheld (see Section 7.6 for further discussion). Sophisticated algorithms enhance specificity of VT therapy and help to avoid VT therapies based on rate criteria alone (1012)(1013)(1014). Beta blockade is also a valuable therapy that will prevent many unwanted device interventions due to supraventricular arrhythmias.…”

Section: Supraventricular Tachyarrhythmiasmentioning

confidence: 99%

“…High-rate atrial antitachycardia pacing may induce (transient) AF. Efficacy of advanced atrial pacing or cardioversion therapies varies greatly in function of episode duration, atrial cycle length, and atrial tachycardia mechanism (1013,1019,1020). Acute efficacy of atrial antitachycardia pacing may be as high as 40% (1013).…”

Section: Dual-chamber Implantable Cardioverter-defibrillatorsmentioning

confidence: 99%

See 1 more Smart Citation

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Zipes¹,

Camm²,

Borggrefe³

et al. 2006

Circulation

1,200

671

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Section: Supraventricular Tachyarrhythmiasmentioning

confidence: 99%

Section: Dual-chamber Implantable Cardioverter-defibrillatorsmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Zipes¹,

Camm²,

Borggrefe³

et al. 2006

Circulation

1,200

671

View full text Add to dashboard Cite

“…Another strategy, anti-tachycardia pacing (ATP), seeks to avoid the development of permanent AF by suppressing paroxysmal AF. ATP consists of a train of 8-10 low-energy stimuli delivered as a pacing ramp or burst at 50Hz via a single pacing electrode 9. ATP is effective in treating spontaneous atrial tachyarrhythmias, especially slower tachycardias,9-10 but it is not very effective for converting AF 9,11-12…”

mentioning

confidence: 99%

Termination of Atrial Fibrillation Using Pulsed Low-Energy Far-Field Stimulation

et al. 2009

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Background-Electrically based therapies for terminating atrial fibrillation (AF) currently fall into 2 categories:antitachycardia pacing and cardioversion. Antitachycardia pacing uses low-intensity pacing stimuli delivered via a single electrode and is effective for terminating slower tachycardias but is less effective for treating AF. In contrast, cardioversion uses a single high-voltage shock to terminate AF reliably, but the voltages required produce undesirable side effects, including tissue damage and pain. We propose a new method to terminate AF called far-field antifibrillation pacing, which delivers a short train of low-intensity electric pulses at the frequency of antitachycardia pacing but from field electrodes. Prior theoretical work has suggested that this approach can create a large number of activation sites ("virtual" electrodes) that emit propagating waves within the tissue without implanting physical electrodes and thereby may be more effective than point-source stimulation. Methods and Results-Using optical mapping in isolated perfused canine atrial preparations, we show that a series of pulses at low field strength (0.9 to 1.4 V/cm) is sufficient to entrain and subsequently extinguish AF with a success rate of 93% (69 of 74 trials in 8 preparations). We further demonstrate that the mechanism behind far-field antifibrillation pacing success is the generation of wave emission sites within the tissue by the applied electric field, which entrains the tissue as the field is pulsed. Conclusions-AF in our model can be terminated by far-field antifibrillation pacing with only 13% of the energy required for cardioversion. Further studies are needed to determine whether this marked reduction in energy can increase the effectiveness and safety of terminating atrial tachyarrhythmias clinically. Key Words: arrhythmia Ⅲ atrium Ⅲ cardioversion Ⅲ fibrillation Ⅲ mapping A trial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide, 1 affecting Ͼ2.2 million people in the United States alone. 2 Complications associated with chronic AF include increased risk for both thromboembolism and stroke. 2 Left untreated, paroxysmal AF often progresses to permanent AF, which is resistant to therapy. 3 Although underlying anatomic or pathophysiological factors may fuel this progression, 3 AF itself may lead to its own perpetuation through electric, structural, and metabolic remodeling of atrial tissue. The realization that AF begets AF 4 has led to management strategies that are designed to avoid the progression of AF by reducing the frequency and duration of AF episodes. Clinical Perspective on p 476One such strategy, cardioversion, attempts to reset all electric activity in the atria and requires the use of large (Ͼ5 V/cm) electric field gradients. 5-7 These high energies cause pain and trauma for the patient, damage the myocardium, and reduce battery life in implanted devices. 8 Another strategy, antitachycardia pacing (ATP), seeks to avoid the development of permanent AF by suppressing paroxysmal A...

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“…Their AT/AF may be treated with a combined atrial and ventricular ICD. Atrial ATP has not been reported to cause ventricular proarrhythmia in patients who do not have either ventricular arrhythmias or significant structural heart disease 2–4 . These patients can be treated using an atrial antitachycardia pacemaker with low or minimal risk.…”

Section: Discussionmentioning

confidence: 99%

Acceleration of Ventricular Rate Following Atrial Antitachycardia Pacing:

Paz

Birgersdotter‐Green

Swerdlow

2003

Cardiovasc electrophysiol

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Safety and efficacy of advanced atrial pacing therapies for atrial tachyarrhythmias in patients with a new implantable dual chamber cardioverter-defibrillator

Abstract: Atrial ATP therapies terminate many episodes of AT without ventricular proarrhythmia. The addition of 50-Hz Burst pacing has minimal efficacy for AT/AF.

Cited by 77 publications

References 18 publications

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Termination of Atrial Fibrillation Using Pulsed Low-Energy Far-Field Stimulation

Acceleration of Ventricular Rate Following Atrial Antitachycardia Pacing:

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