Clinical shock tolerability and effect of different right atrial electrode locations on efficacy of low energy human transvenous atrial defibrillation using an implantable lead system

被引:70
作者
Lok, NS
Lau, CP
Tse, HF
Ayers, GM
机构
[1] UNIV HONG KONG,QUEEN MARY HOSP,DEPT MED,DIV CARDIOL,HONG KONG,HONG KONG
[2] INCONTROL INC,REDMOND,WA
关键词
D O I
10.1016/S0735-1097(97)00298-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. The objectives of this study were 1) to evaluate the effect of different right atrial electrode locations on the efficacy of low energy transvenous defibrillation with an implantable lead system; and 2) to qualitate and quantify the discomfort from atrial defibrillation shocks delivered by a clinically relevant method. Background. Biatrial shocks result in the lowest thresholds for transvenous atrial defibrillation, but the optimal right atrial and coronary sinus electrode locations for defibrillation efficacy in humans have not been defined, Methods. Twenty-eight patients (17 men, 11 women) with chronic atrial fibrillation (AF) (lasting greater than or equal to 1 month) were studied, Transvenous atrial defibrillation was performed by delivering R cave-synchronized biphasic shocks with incremental shack levels (from 180 to 100 V in steps of 40 V). Different electrode location combinations were used and tested randomly: the anterolateral, inferomedial right atrium or high right atrial appendage to the distal coronary sinus, Defibrillation thresholds were defined in duplicate by using the step-up protocol, Pain perception of shack delivery was assessed by using a purpose-designed questionnaire; sedation was given when the shock level was unacceptable (tolerability threshold). Results, Sinus rhythm was restored in 26 of 28 patients by using at least one of the right atrial electrode locations tested, The conversion rate with the anterolateral right atrial location (21 [81%] of 26) was higher than that with the inferomedial right atrial location (8 [50%] of 16, p < 0.05) but similar to that with the high right atrial appendage location (16 [89%] of 18, p > 0.05). The mean defibrillation thresholds for the high right atrial appendage, anterolateral right atrium and inferomedial right atrium were all significantly different with respect to energy (3.9 +/- 1.8 J vs. 4.6 +/- 1.8 J vs, 6.0 +/- 1.7 J, respectively, p < 0.05) and voltage (317 +/- 77 V vs. 348 +/- 70 V vs, 396 +/- 66 V, respectively, p < 0.05). Patients tolerated a mean of 3.4 +/- 2 shocks with a tolerability threshold of 255 +/- 60 V, 2.5 +/- 1.3 J. Conclusions. Low energy transvenous defibrillation with an implantable defibrillation lead system is an effective treatment for AF. Most patients earn tolerate two to three shocks, and, when the starting shock level (180 V) is close to the defibrillation threshold, they can tolerate on average a shock level of 260 V without sedation, Electrodes should be positioned in the distal coronary sinus and in the high right atrial appendage to achieve the lowest defibrillation threshold, although other locations may be suitable for certain patients. (C) 1997 by the American College of Cardiology.
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页码:1324 / 1330
页数:7
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