Document Detail


Hemodynamic effects and clinical determinants of defibrillation threshold for transvenous atrial defibrillation using biatrial biphasic shocks in patients with chronic atrial fibrillation.
MedLine Citation:
PMID:  9127394     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We assessed the relationship between the hemodynamic changes and shock intensity in transvenous atrial defibrillation for chronic AF. The correlation between the clinical profile and atrial DFT and the factors predicting maintenance of SR after successful defibrillation were also investigated. Atrial defibrillation using entirely transvenous leads has been investigated as an alternative means of managing patients with AF. However, the hemodynamic consequence of this technique and the clinical factors predicting defibrillation efficacy have not been evaluated. Thirty-seven patients with chronic AF (4 weeks to 60 months) underwent transvenous atrial defibrillation. Defibrillation was performed by delivering R wave synchronized, biphasic (3/3 ms) shocks with step-up voltages (20-400 V) between defibrillation catheters in the anterolateral right atrium and the distal coronary sinus. Clinical profile of the patients, the DFT, arterial blood pressure, and RR interval during defibrillation and the 6-month recurrence rate were determined. SR was restored in 33 (89%) of 37 patients and the DFT was 3.7 +/- 1.4 J (317 +/- 58 V). Transvenous atrial defibrillation resulted in a mild reduction in blood pressure (6 +/- 10 mmHg), but substantial prolongation of longest postshock RR intervals (507 +/- 546 ms), which were significantly related to the shock intensity (r = 0.5, P < 0.001). There was no ventricular proarrhythmia. The patients' age, body weight, duration of AF, left atrial diameter, and ejection fraction were not related to the success of defibrillation, not the 6-month maintenance rate of SR (39%). However, the patients' age was related to DFT. Apart from transient reduction in blood pressure and shock related pauses that may require backup pacing, transvenous biatrial defibrillation was a highly effective and well-tolerated technique. The absence of clinical determinant for successful defibrillation suggests that restoring SR by transvenous atrial defibrillation could be attempted in most patients with chronic AF.
Authors:
N S Lok; C P Lau; D S Ho; Y W Tang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  20     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1997 Apr 
Date Detail:
Created Date:  1997-07-10     Completed Date:  1997-07-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  899-908     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Atrial Fibrillation / physiopathology,  therapy*
Blood Pressure
Chronic Disease
Electric Countershock / methods*
Female
Heart Rate
Hemodynamics*
Humans
Male
Middle Aged
Prospective Studies
Recurrence

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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