Induction of atrial fibrillation with low-energy defibrillator shocks in patients with implantable cardioverter defibrillators

In a population of 151 consecutive patients who received an implantable cardioverter defibrillator, we found that atrial fibrillation was induced by low-energy shocks in 19% and was most common in patients with lead systems that included a right atrial electrode. Our finding that there was a fixed relation between the energy required to fibrillate (less than or equal to 3 J) and defibrillate (>3 J) suggests the presence of an upper limit of vulnerability in the human atrium.