Atrial defibrillation with a transvenous lead - A randomized comparison of active can shocking pathways

被引:17
作者
Cooklin, M [1 ]
Olsovsky, MR [1 ]
Brockman, RG [1 ]
Shorofsky, SR [1 ]
Gold, MR [1 ]
机构
[1] Univ Maryland, Med Syst, Dept Med, Div Cardiol, Baltimore, MD 21201 USA
关键词
D O I
10.1016/S0735-1097(99)00214-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The purpose of this study was to compare transvenous atrial defibrillation thresholds with lead configurations consisting of an active left pectoral electrode and either single or dual transvenous coils. BACKGROUND Low atrial defibrillation thresholds are achieved using complex lead systems including coils in the coronary sinus. However, the efficacy of more simple ventricular defibrillation leads with active pectoral pulse generators to defibrillate atrial fibrillation (AF) is unknown. METHODS This study was a prospective, randomized assessment of shock configuration on aerial defibrillation thresholds in 32 patients. The lead system was a dual coil Endotak DSP lead with a left pectoral pulse generator emulator. Shocks were delivered either between the right ventricular coil and an active can in common with the proximal atrial coil (triad) or between the atrial coil and active can (transatrial). RESULTS Delivered energy at defibrillation threshold was 7.1 +/- 6.0 J in the transatrial configuration and 4.0 +/- 4.2 J in the triad configuration (p < 0.005). Moreover, a low threshold (less than or equal to 3 J) was observed in 69% of subjects in the triad configuration but only 47% in the transatrial configuration. Peak voltage and shock impedance were also lowered significantly in the triad configuration. Left atrial size was the only clinical predictor of the defibrillation threshold (r = 0.57, p < 0.002). CONCLUSIONS These results indicate that low atrial defibrillation thresholds can be achieved using a single-pass transvenous ventricular defibrillation lead with a conventional ventricular defibrillation pathway. These data support the development-of the combined atrial and ventricular defibrillator system. (C) 1999 by the American College of Cardiology.
引用
收藏
页码:358 / 362
页数:5
相关论文
共 29 条
[1]   LEAD SYSTEMS FOR ATRIAL DEFIBRILLATION [J].
ALFERNESS, C ;
AYERS, GM ;
COOPER, RAS ;
IDEKER, RE .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1994, 17 (05) :1043-1047
[2]   INITIAL EXPERIENCE WITH INTRACARDIAC ATRIAL DEFIBRILLATION IN PATIENTS WITH CHRONIC ATRIAL-FIBRILLATION [J].
ALT, E ;
SCHMITT, C ;
AMMER, R ;
COENEN, M ;
FOTUHI, P ;
KARCH, M ;
BLASINI, R .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1994, 17 (05) :1067-1078
[3]   VENTRICULAR PROARRHYTHMIC EFFECTS OF VENTRICULAR CYCLE LENGTH AND SHOCK STRENGTH IN A SHEEP MODEL OF TRANSVENOUS ATRIAL DEFIBRILLATION [J].
AYERS, GM ;
ALFERNESS, CA ;
ILINA, M ;
WAGNER, DO ;
SIROKMAN, WA ;
ADAMS, JM ;
GRIFFIN, JC .
CIRCULATION, 1994, 89 (01) :413-422
[4]   Cardioversion of atrial fibrillation in the elderly [J].
Carlsson, J ;
Tebbe, U ;
Rox, J ;
Harmjanz, D ;
Haerten, K ;
Neuhaus, KL ;
Seidel, F ;
Niederer, W ;
Miketic, S .
AMERICAN JOURNAL OF CARDIOLOGY, 1996, 78 (12) :1380-1384
[5]  
Cooper RAS, 1997, CIRCULATION, V95, P1487
[6]   Marked reduction in internal atrial defibrillation thresholds with dual-current pathways and sequential shocks in humans [J].
Cooper, RAS ;
Plumb, VJ ;
Epstein, AE ;
Kay, GN ;
Ideker, RE .
CIRCULATION, 1998, 97 (25) :2527-2535
[7]   INTERNAL CARDIOVERSION OF ATRIAL-FIBRILLATION IN SHEEP [J].
COOPER, RAS ;
ALFERNESS, CA ;
SMITH, WM ;
IDEKER, RE .
CIRCULATION, 1993, 87 (05) :1673-1686
[8]   Induction of atrial fibrillation with low-energy defibrillator shocks in patients with implantable cardioverter defibrillators [J].
Florin, TJ ;
Weiss, DN ;
Peters, RW ;
Shorofsky, SR ;
Gold, MR .
AMERICAN JOURNAL OF CARDIOLOGY, 1997, 80 (07) :960-&
[9]   Clinical predictors of transvenous biphasic defibrillation thresholds [J].
Gold, MR ;
Khalighi, K ;
Kavesh, NG ;
Daly, B ;
Peters, RW ;
Shorofsky, SR .
AMERICAN JOURNAL OF CARDIOLOGY, 1997, 79 (12) :1623-1627
[10]   Effects of an active pectoral-pulse generator shell on defibrillation efficacy with a transvenous lead system [J].
Gold, MR ;
Foster, AH ;
Shorofsky, SR .
AMERICAN JOURNAL OF CARDIOLOGY, 1996, 78 (05) :540-543