Document Detail


Atrial fibrillation/flutter induced by implantable ventricular defibrillator shocks: difference between epicardial and endocardial energy delivery.
MedLine Citation:
PMID:  9116966     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: We evaluated the incidence and energy dependence of atrial fibrillation/flutter (AF) induced by implantable ventricular defibrillator shocks in 63 patients tested in the operating room or electrophysiology laboratory. METHODS AND RESULTS: Defibrillator shocks were epicardial monophasic in 32 patients, and through an Endotak lead endocardial monophasic in 19 and biphasic in 12 patients. The epicardial and endocardial patient groups had similar clinical characteristics. A total of 517 defibrillator shocks were given. The epicardial group received 336 total defibrillator shocks and 10 +/- 6 shocks (mean +/- SD) per patient compared with the endocardial group, which received 181 total shocks and 6 +/- 4 defibrillator shocks per patient (P = 0.004). In the epicardial group, AF occurred in 13 (41%) patients and in 17 (5%) of the 336 shocks. No AF was induced with endocardial defibrillator shocks. The epicardial mean energy was 16 +/- 9 J, lower than the endocardial mean energy of 20 +/- 9 J (P < 0.004). In the epicardial monophasic group, energy correlated with AF induction. Each patient received 7 +/- 6 defibrillator shocks < 15 J and 4 +/- 2 shocks > or = 15 J, yet AF occurred in only 2.3% versus 9.6% (P < 0.05) of defibrillator shocks < 15 J and > or = 15 J, respectively. Of note, AF was not induced with energy < 4 J or > 31 J. CONCLUSIONS: In the epicardial configuration, AF induction is energy dependent, with an apparent lower and upper limit of vulnerability. AF induction by defibrillator shocks delivered through an Endotak lead is very rare, possibly related to an apparent upper limit of vulnerability of less energy, avoidance of thoracotomy, or different energy field distribution.
Authors:
A Katz; J J Evans; R I Fogel; J J Schier; R G Matheny; G M Baranowski; E N Prystowsky
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  8     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-04-22     Completed Date:  1997-04-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  35-41     Citation Subset:  IM    
Affiliation:
Indiana Heart Institute, Indianapolis, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Atrial Flutter / etiology*
Defibrillators, Implantable / adverse effects*
Electrophysiology
Female
Humans
Male
Middle Aged

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