Determinants of first-shock success for atrial implantable cardioverter defibrillators

被引:13
作者
Swerdlow, CD
Schwartzman, D
Hoyt, R
Bailin, SJ
Koehler, JL
Warman, EN
机构
[1] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA
[2] Iowa Heart Ctr, Des Moines, IA USA
[3] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA
[4] Medtronic Inc, Minneapolis, MN USA
关键词
atrial fibrillation; implantable cardioverter defibrillator;
D O I
10.1046/j.1540-8167.2002.00347.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: The aim of this study was to identify determinants of first-shock success for defibrillation of spontaneous atrial fibrillation (AF) in ambulatory patients with an atrial implantable cardioverter defibrillator (ICD). The determinants of first-shock success in ambulatory patients with atrial ICDs are unknown. Methods and Results: We used the generalized estimating equation method to analyze determinants of first-shock success in 50 consecutive atrial ICD recipients in whom DFT+ (weakest shock that defibrillates on two consecutive trials) was determined at implant and spontaneous AF was shocked with shock strength greater than or equal to2x DFT+. DFT+ was 6.2 +/- 3.1 J. Of 470 first shocks, 407 were successful (generalized estimating equation 85%, confidence interval 79% to 90%). Determinants of first-shock success were use of coronary sinus electrode (univariate P = 0.02; multivariate P < 0.001, relative risk 5.0), absence of a Class III antiarrhythmic drug (univariate P = 0.06; multivariate P < 0.001, relative risk 3.2), absence of early recurrence of atrial fibrillation (ERAF; univariate P = 0.06; multivariate P = 0.02, relative risk 2.9), and longer duration of AF prior to shock greater than or equal to3 hours (univariate: P = 0.02; multivariate P = NS). Sinus rhythm >1 minute persisted after 93% of first shocks in patients without documented ERAF but after only 58% of shocks in patients with documented ERAF (P < 0.001). Conclusion: Reducing ERAF is critical to achieving a clinically acceptable rate of persistent sinus rhythm after first shocks. For first shocks greater than or equal to2x DFT+, success is not increased by programming stronger shocks. Early cardioversion does not increase first-shock success.
引用
收藏
页码:347 / 354
页数:8
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