Copyright © 2001 by the European Society of Cardiology.
Atrial defibrillation threshold in humans minutes after atrial fibrillation induction. ‘a stitch in time saves nine’
a Department of Cardiology, Heraklion University Hospital, Heraklion-Crete, Greece
b Department of Anesthesiology, Heraklion University Hospital, Heraklion-Crete, Greece
revised November 27, 2000; accepted November 29, 2000
Abstract
Aims To assess the effects of atrial fibrillation duration on the defibrillation threshold in atrial fibrillation patients seconds or minutes after initiation of the arrhythmia.
Methods and Results Nineteen patients with recurrent symptomatic atrial fibrillation were evaluated. After programmed induction of atrial fibrillation, the defibrillation threshold was assessed after two sequential periods of arrhythmia in the same patient: an ‘ultrashort’ period of 30s duration and a ‘short’ period, which lasted 10min. After the specified period, internal cardioversion was attempted using a balloon-guided catheter that allows the delivery of biphasic shocks between one electrode array placed in the left pulmonary artery and a proximal electrode array on the lateral right atrial wall. The defibrillation threshold was assessed with energy steps of 0·5J with a starting level of 0·5J. Mean time from induction to successful defibrillation was 92±30s after the ‘ultrashort’ period of atrial fibrillation and 910±86s after the short period. The defibrillation threshold was significantly greater after 10min of atrial fibrillation than after 30s of arrhythmia (2·32±0·61J vs 1·31±0·66J, P<0·001). Clinical data were not found to affect the defibrillation threshold.
Conclusions Prolongation of atrial fibrillation over minutes in patients with paroxysmal arrhythmia increases the energy requirements for successful defibrillation.
Key Words: Atrial fibrillation, defibrillation threshold
f1 Correspondence: Prof. Panos E. Vardas, MD, PhD, Department of Cardiology, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece.
References
- Lok NS, Lau CP, Tse HF, Ayers GM. 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. J Am Coll Cardiol. 1997;30:1324–1330[Abstract]
- Ammer R, Alt E, Ayers G. Pain threshold for low energy intracardiac cardioversion of atrial fibrillation with low or no sedation. Pacing Clin Electrophysiol. 1997;20:230–236[CrossRef][Medline]
- Alt E, Schmitt C, Ammer R. Effect of electrode position on outcome of low-energy intracardiac cardioversion of atrial fibrillation. Am J Cardiol. 1997;79:621–625[CrossRef][Web of Science][Medline]
- Cooper RA, Plumb VJ, Epstein AE, Kay GN, Ideker RE. Marked reduction in internal atrial defibrillation thresholds with dual-current pathways and sequential shocks in humans. Circulation. 1998;97:2527–2535
[Abstract/Free Full Text] - Murgatroyd FD, Slade AKB, Sopher SM, Rowland E, Ward DE, Camm J. Efficacy and tolerability of transvenous low energy cardioversion of paroxysmal atrial fibrillation in humans. J Am Coll Cardiol. 1995;25:1347–1353[Abstract]
- Levy S, Ricard P, Lau CP. Multicenter low energy transvenous atrial defibrillation (XAD) trial results in different subsets of atrial fibrillation. J Am Coll Cardiol. 1997;29:750–755[Abstract]
- Ammer R, Lehmann G, Plewan A, Puetter K, Alt E. Marked reduction in atrial defibrillation thresholds with repeated internal cardioversion. J Am Coll Cardiol. 1999;34:1569–1576
[Abstract/Free Full Text] - Gaita F, Riccardi R, Calo L. Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation. Electrophysiological findings and ablation results. Circulation. 1998;97:2136–2145
[Abstract/Free Full Text] - Fotuhi PC, Cooper RAS, Speenan CM, Rollins DL, Smith WM, Ideker RE. Can early internal atrial defibrillation shocks reduce the atrial defibrillation threshold? Pacing Clin Electrophysiol. 1999;22:1179–1185[CrossRef][Medline]
- Wijffels MCEF, Kirchhof CJHJ, Dorland R, Allesie MA. Atrial fibrillation begets atrial fibrillation. A study in wake chronically instrumented goats. Circulation. 1995;92:1954–1968
[Abstract/Free Full Text] - Wijffels MCEF, Kirchhof CJHJ, Dorland R, Power J, Allesie MA. Electrical remodeling due to atrial fibrillation in chronically instrumented conscious goats. Roles of neurohumoral changes, ischemia, atrial stretch, and high rate of electrical activation. Circulation. 1997;96:3710–3720
[Abstract/Free Full Text] - Strobel JS, Kenknight BH, Rollins DL, Smith WM, Ideker RE. The effects of ventricular fibrillation duration and site of initiation on the defibrillation threshold during early ventricular fibrillation. J Am Coll Cardiol. 1998;32:521–527
[Abstract/Free Full Text] - Daoud EG, Bogun F, Goyal R. Effect of AF on atrial refractoriness in humans. Circulation. 1996;94:1600–1606
[Abstract/Free Full Text] - Lavoie J, Walsh EP, Burrows FA, Laussen P, Lulu JA, Hansen DD. Effects of propofol or isoflurane anesthesia on cardiac conduction in children undergoing radiofrequency catheter ablation for tachydysrhythmias. Anesthesiology. 1995;82:884–887[Web of Science][Medline]
- Moerman A, Herregods L, Tavernier R, Jordaens L, Struys M, Rolly G. Influence of anaesthesia on defibrillation threshold. Anaesthesia. 1998;53:1156–1159[CrossRef][Web of Science][Medline]
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