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Article: Effect of coronary sinus electrode on the optimal atrial defibrillation pathway for an atrioventricular defibrillator

TitleEffect of coronary sinus electrode on the optimal atrial defibrillation pathway for an atrioventricular defibrillator
Authors
Issue Date2003
PublisherWiley-Blackwell Publishing, Inc.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=1045-3873
Citation
Journal Of Cardiovascular Electrophysiology, 2003, v. 14 n. 1, p. 32-37 How to Cite?
AbstractIntroduction: Previous studies have demonstrated significant failure in converting atrial fibrillation (AF) using a conventional ventricular pathway. The aim of this study was to assess the benefit of incorporating a coronary sinus (CS) lead into the atrial defibrillation pathway in atrial defibrillation threshold (ADFT) reduction in patients with persistent AF. Methods and Results: This study was a prospective, randomized assessment of shock configuration on ADFT in 18 patients undergoing elective internal cardioversion for persistent AF (mean AF duration: 8 ± months). The lead system included a dual-coil defibrillation lead (Endotak DSP, Guidant) with a distal right ventricular (RV) electrode and a proximal superior vena cava (SVC) electrode, a CS lead (Perimeter, Guidant), and a left pectoral cutaneous electrode (Can). In each patient, dual step-up ADFTs were determined for each of three vectors: (1) RV → SVC+Can; (2) CS → SVC+Can; and (3) RV → CS+SVC+Can (group 1, n = 8) or RV+CS → SVC+Can (group 2, n = 10), using R wave-synchronized biphasic shocks. Successful defibrillation was achieved in all patients without any ventricular proarrhythmia. ADFT of CS → SVC+Can (11.8 ± 5.6 J) was significantly lower than ADFT of RV → SVC+Can (16.5 ± 7.8 J, P = 0.021). ADFT of CS → SVC+Can was similar to RV → CS+SVC+Can (group 1: 12.0 ± 6.5 J vs 17.4 ± 4.8 J, P = 0.16), but it was significantly higher than RV+CS → SVC+Can (group 2: 9.0 ± 3.9 J vs 11.6 ± 5.0 J, P = 0.049). Conclusion: Patients with persistent AF of substantial duration can be reliably cardioverted using a conventional implantable cardioverter defibrillator (ICD) lead set; however, the incorporation of a CS lead to the conventional ICD lead configuration significantly lowered ADFT. The optimal shock vector that incorporates a CS lead for atrial defibrillation requires future studies.
Persistent Identifierhttp://hdl.handle.net/10722/162669
ISSN
2015 Impact Factor: 3.097
2015 SCImago Journal Rankings: 1.863
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTse, HFen_US
dc.contributor.authorTimmermans, Cen_US
dc.contributor.authorRodriguez, LMen_US
dc.contributor.authorLau, CPen_US
dc.contributor.authorWellens, HJJen_US
dc.date.accessioned2012-09-05T05:22:12Z-
dc.date.available2012-09-05T05:22:12Z-
dc.date.issued2003en_US
dc.identifier.citationJournal Of Cardiovascular Electrophysiology, 2003, v. 14 n. 1, p. 32-37en_US
dc.identifier.issn1045-3873en_US
dc.identifier.urihttp://hdl.handle.net/10722/162669-
dc.description.abstractIntroduction: Previous studies have demonstrated significant failure in converting atrial fibrillation (AF) using a conventional ventricular pathway. The aim of this study was to assess the benefit of incorporating a coronary sinus (CS) lead into the atrial defibrillation pathway in atrial defibrillation threshold (ADFT) reduction in patients with persistent AF. Methods and Results: This study was a prospective, randomized assessment of shock configuration on ADFT in 18 patients undergoing elective internal cardioversion for persistent AF (mean AF duration: 8 ± months). The lead system included a dual-coil defibrillation lead (Endotak DSP, Guidant) with a distal right ventricular (RV) electrode and a proximal superior vena cava (SVC) electrode, a CS lead (Perimeter, Guidant), and a left pectoral cutaneous electrode (Can). In each patient, dual step-up ADFTs were determined for each of three vectors: (1) RV → SVC+Can; (2) CS → SVC+Can; and (3) RV → CS+SVC+Can (group 1, n = 8) or RV+CS → SVC+Can (group 2, n = 10), using R wave-synchronized biphasic shocks. Successful defibrillation was achieved in all patients without any ventricular proarrhythmia. ADFT of CS → SVC+Can (11.8 ± 5.6 J) was significantly lower than ADFT of RV → SVC+Can (16.5 ± 7.8 J, P = 0.021). ADFT of CS → SVC+Can was similar to RV → CS+SVC+Can (group 1: 12.0 ± 6.5 J vs 17.4 ± 4.8 J, P = 0.16), but it was significantly higher than RV+CS → SVC+Can (group 2: 9.0 ± 3.9 J vs 11.6 ± 5.0 J, P = 0.049). Conclusion: Patients with persistent AF of substantial duration can be reliably cardioverted using a conventional implantable cardioverter defibrillator (ICD) lead set; however, the incorporation of a CS lead to the conventional ICD lead configuration significantly lowered ADFT. The optimal shock vector that incorporates a CS lead for atrial defibrillation requires future studies.en_US
dc.languageengen_US
dc.publisherWiley-Blackwell Publishing, Inc.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=1045-3873en_US
dc.relation.ispartofJournal of Cardiovascular Electrophysiologyen_US
dc.subject.meshAgeden_US
dc.subject.meshAtrial Fibrillation - Physiopathology - Therapyen_US
dc.subject.meshAtrioventricular Node - Physiopathology - Surgeryen_US
dc.subject.meshElectric Countershocken_US
dc.subject.meshElectric Impedanceen_US
dc.subject.meshElectrocardiographyen_US
dc.subject.meshElectrodes, Implanteden_US
dc.subject.meshElectrophysiologic Techniques, Cardiacen_US
dc.subject.meshFemaleen_US
dc.subject.meshHeart Atria - Physiopathology - Surgeryen_US
dc.subject.meshHeart Ventricles - Physiopathology - Surgeryen_US
dc.subject.meshHong Kongen_US
dc.subject.meshHumansen_US
dc.subject.meshIncidenceen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshNetherlandsen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshRandomized Controlled Trials As Topicen_US
dc.subject.meshStroke Volume - Physiologyen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleEffect of coronary sinus electrode on the optimal atrial defibrillation pathway for an atrioventricular defibrillatoren_US
dc.typeArticleen_US
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1046/j.1540-8167.2003.02354.xen_US
dc.identifier.pmid12625607-
dc.identifier.scopuseid_2-s2.0-0037284119en_US
dc.identifier.hkuros100805-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0037284119&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume14en_US
dc.identifier.issue1en_US
dc.identifier.spage32en_US
dc.identifier.epage37en_US
dc.identifier.isiWOS:000181036400007-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.scopusauthoridTimmermans, C=7006153844en_US
dc.identifier.scopusauthoridRodriguez, LM=7402239863en_US
dc.identifier.scopusauthoridLau, CP=7401968501en_US
dc.identifier.scopusauthoridWellens, HJJ=35395866600en_US

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