Document Detail


How, why, and when may atrial defibrillation find a specific role in implantable devices? A clinical viewpoint.
MedLine Citation:
PMID:  17367364     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This viewpoint article discusses the potential for incorporation of atrial defibrillation capabilities in modern multi-chamber devices. In the late 1990s, the possibility of using shock-only therapy to treat selected patients with recurrent atrial fibrillation (AF) was explored in the context of the stand-alone atrial defibrillator. The failure of this strategy can be attributed to the technical limitations of the stand-alone device, low tolerance of atrial shocks, difficulties in patient selection, a lack of predictive knowledge about the evolution of AF, and, last but not least, commercial considerations. An open question is how atrial defibrillation capability may now assume a specific new role in devices implanted for sudden death prevention or cardiac resynchronization. For patients who already have indications for implantable devices, device-based atrial defibrillation appears attractive as a "backup" option for managing AF when preventive pharmacological/electrical measures fail. This and several other personalized hybrid therapeutic approaches await exploration, though assessment of their efficacy is methodologically challenging. Achievement of acceptance by patients is an essential premise for any updated atrial defibrillation strategy. Strategies that are being investigated to improve patient tolerance include waveform shaping, pharmacologic modulation of pain, and patient-activated defibrillation (patients might also perceive the problem of discomfort somewhat differently in the context of a backup therapy). The economic impact of implementing atrial defibrillation features in available devices is progressively decreasing, and financial feasibility need not be a major issue. Future studies should examine clinically relevant outcomes and not be limited (as occurred with stand-alone defibrillators) to technical or other soft endpoints.
Authors:
Giuseppe Boriani; Igor Diemberger; Mauro Biffi; Cristian Martignani; Matteo Ziacchi; Matteo Bertini; Cinzia Valzania; Gabriele Bronzetti; Claudio Rapezzi; Angelo Branzi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  30     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-19     Completed Date:  2007-05-31     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:  422-33     Citation Subset:  IM    
Affiliation:
Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy. giuseppe.boriani@unibo.it
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / prevention & control*
Cardiac Pacing, Artificial / trends*
Defibrillators, Implantable / trends*
Electric Countershock / instrumentation,  trends*
Humans
Pacemaker, Artificial / trends*
Patient Selection
Physician's Practice Patterns / trends
Practice Guidelines as Topic

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


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