Copyright © 2003 by the European Society of Cardiology.
Clinical research
Treatment of atrial fibrillation with an implantable atrial defibrillator — long term results
a University Hospitals of Magdeburg, Magdeburg, Germany
b Academic Hospital Maastricht, Maastricht, Netherlands
c Guidant Inc. Europe, Brussels, Belgium
d Queen Mary Hospital, University of Hong Kong, Hong Kong China
e University of Mannheim, Mannheim, Germany
f Academic Hospital Villingen, Villingen, Germany
g St. George's Hospital, London, UK
* Correspondence to: J. Christoph Geller, M.D., Division of Cardiology, University Hospitals, Otto-von-Guericke University, Leipzigerstrasse 44, 39120 Magdeburg, Germany. Tel: ++49-391-671 3203; Fax: +49-391-671 3202
E-mail address: christoph.geller{at}medizin.uni-magdeburg.de
Received 25 March 2003; revised 26 August 2003; accepted 18 September 2003
Abstract
Objectives To evaluate the long-term outcome with an implantable atrial defibrillator (IAD) in patients with recurrent atrial fibrillation (AF).
Background Maintenance of sinus rhythm using repeated internal cardioversion shocks has been shown to be effective and safe in short-term studies but long term follow-up is unknown.
Methods Since 1995, 136 patients (30 women) with symptomatic, drug-refractory atrial fibrillation were implanted with an IAD (METRIX, InControl). This analysis was performed after a median of 40 (range 7–66) months after implantation.
Results In 26 patients, the programmed mode was not documented during last follow-up, four patients had died. Of the remaining 106 patients (mean age 58±10, range 34 – 79 years), 39 were actively delivering therapy with the device, in 14 patients the device was used to monitor the arrhythmia but no shocks were delivered, and in 53 patients it was turned off or explanted. Increases in defibrillation thresholds (n=7), patient intolerance of multiple cardioversion shocks (n=15), and significant bradycardia requiring dual-chamber pacing (n=12) were the main reasons for discontinuation of therapy in addition to battery depletion (n=19). After explantation, efforts to maintain sinus rhythm were continued in 17 patients whereas rate control was attempted in 36 patients.
Conclusions A strategy of maintaining sinus rhythm long-term with an IAD is feasible in a proportion of patients. However, patient selection is critical, and technical improvements (i.e. higher shock energies, dual-chamber pacing and additional preventive and anti-tachycardia pacing algorithms) are required to increase the number of patients having long term benefit, and frequent arrhythmia recurrences and patient intolerance to repeated cardioversion shocks remain a major limitation.
Key Words: Atrial fibrillation • Heart assist device • Defibrillation
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- ‘The patient takes charge’ — long term use of the atrial defibrillator
- Andrew R.J. Mitchell
EHJ 2003 24: 2075-2076.[Extract] [FREE Full Text]
This article has been cited by other articles:
|
|
 |
|
  A. R.J. Mitchell, A. E. Epstein, and For the AFFIRM Investigators Non-Pharmacological Methods of Maintaining Sinus Rhythm * Response Circulation, August 10, 2004; 110(6): e61 - e61. [Full Text] [PDF]
|
|
|
|
 |
|
 A. R.J. Mitchell 'The patient takes charge' -- long term use of the atrial defibrillator Eur. Heart J., December 1, 2003; 24(23): 2075 - 2076. [Full Text] [PDF]
|
|