Document Detail

Rapid atrial pacing does not decrease the atrial defibrillation threshold.
MedLine Citation:
PMID:  12914622     Owner:  NLM     Status:  MEDLINE    
The aim of the study was to evaluate the effect of preshock atrial pacing on the atrial defibrillation threshold (DFT) during internal cardioversion of AF. The implantable atrial defibrillator has been added to the therapeutic options for patients with recurrent episodes of persistent AF. Although the device is efficient in restoring sinus rhythm, patient discomfort is a limitation. Methods that lower the ADFT are needed. Eleven patients with AF underwent internal cardioversion. In a randomized, crossover design, ADFT testing was performed, applying a step-up protocol starting at 100 V. Rapid atrial pacing was performed with a right atrial catheter for 20 seconds at 90% of the average cycle length of the fibrillatory waves and was immediately followed by a biphasic defibrillation shock. At each energy level, pacing + shock was compared to shock only, until the level at which sinus rhythm was restored by both modes. The step-up protocol was thereafter repeated using the inverse sequence of the two modes. A total of 19 ADFTs were obtained. For 10 the ADFT was lower with pacing + shock, in 4 equal and in 5 higher, than with shock only. The ADFT (mean +/- SD) with pacing + shock was 260 +/- 84 V(3.4 +/- 2.9 J) and did not differ from shock only: 268 +/- 85 V(3.8 +/- 3.0 J) (P > 0.05). The coefficient of variation and the coefficient of reproducibility for pacing + shock was 16% and 60 V, respectively, and for shock only 17% and 61 V. Rapid atrial pacing did not influence the internal ADFT in AF. The randomized, crossover protocol used was reproducible between different modes, and seems useful when testing the impact of different interventions on the ADFT.
Viveka Frykman; Borje Darpo; Gregory M Ayers; Lennart Bergfeldt; Cecilia Linde; Marten Rosenqvist
Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  26     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-08-13     Completed Date:  2003-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1461-6     Citation Subset:  IM    
Department of Cardiology, Karolinska Hospital, Stockholm Sweden.
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MeSH Terms
Atrial Fibrillation / physiopathology,  therapy*
Cardiac Pacing, Artificial / methods*
Cross-Over Studies
Defibrillators, Implantable* / adverse effects
Electric Countershock / adverse effects,  methods*
Electrophysiologic Techniques, Cardiac
Middle Aged
Single-Blind Method

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

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