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Article: Treatment of atrial fibrillation with an implantable atrial defibrillator - Long term results

TitleTreatment of atrial fibrillation with an implantable atrial defibrillator - Long term results
Authors
Issue Date2003
PublisherOxford University Press. The Journal's web site is located at http://eurheartj.oxfordjournals.org/
Citation
European Heart Journal, 2003, v. 24 n. 23, p. 2083-2089 How to Cite?
AbstractObjectives: To evaluate the long-term outcome with an implantable atrial defibrillator (IAD) in patients with recurrent atrial fibrillation (AF). Background: Maintenance of sinus rhythm using repeated internal cardioversion shocks has been shown to be effective and safe in short-term studies but long term follow-up is unknown. Methods: Since 1995, 136 patients (30 women) with symptomatic, drug-refractory atrial fibrillation were implanted with an IAD (METRIX, InControl.). This analysis was performed after a median of 40 (range 7-66) months after implantation. Results: In 26 patients, the programmed mode was not documented during last follow-up, four patients had died. Of the remaining 106 patients (mean age 58±10, range 34-79 years), 39 were actively delivering therapy with the device, in 14 patients the device was used to monitor the arrhythmia but no shocks were delivered, and in 53 patients it was turned off or explanted. Increases in defibrillation thresholds (n=7), patient intolerance of multiple cardioversion shocks (n=15), and significant bradycardia requiring dual-chamber pacing (n=12) were the main reasons for discontinuation of therapy in addition to battery depletion (n=19). After explantation, efforts to maintain sinus rhythm were continued in 17 patients whereas rate control was attempted in 36 patients. Conclusions: A strategy of maintaining sinus rhythm long-term with an IAD is feasible in a proportion of patients. However, patient selection is critical, and technical improvements (i.e. higher shock energies, dual-chamber pacing and additional preventive and anti-tachycardia pacing algorithms) are required to increase the number of patients having long term benefit, and frequent arrhythmia recurrences and patient intolerance to repeated cardioversion shocks remain a major limitation. © 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology.
Persistent Identifierhttp://hdl.handle.net/10722/162770
ISSN
2015 Impact Factor: 15.064
2015 SCImago Journal Rankings: 6.997
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorGeller, JCen_US
dc.contributor.authorReeka, Sen_US
dc.contributor.authorTimmermans, Cen_US
dc.contributor.authorKayser, Ten_US
dc.contributor.authorTse, HFen_US
dc.contributor.authorWolpert, Cen_US
dc.contributor.authorJung, Wen_US
dc.contributor.authorCamm, AJen_US
dc.contributor.authorLau, CPen_US
dc.contributor.authorWellens, HJJen_US
dc.contributor.authorKlein, HUen_US
dc.date.accessioned2012-09-05T05:23:18Z-
dc.date.available2012-09-05T05:23:18Z-
dc.date.issued2003en_US
dc.identifier.citationEuropean Heart Journal, 2003, v. 24 n. 23, p. 2083-2089en_US
dc.identifier.issn0195-668Xen_US
dc.identifier.urihttp://hdl.handle.net/10722/162770-
dc.description.abstractObjectives: To evaluate the long-term outcome with an implantable atrial defibrillator (IAD) in patients with recurrent atrial fibrillation (AF). Background: Maintenance of sinus rhythm using repeated internal cardioversion shocks has been shown to be effective and safe in short-term studies but long term follow-up is unknown. Methods: Since 1995, 136 patients (30 women) with symptomatic, drug-refractory atrial fibrillation were implanted with an IAD (METRIX, InControl.). This analysis was performed after a median of 40 (range 7-66) months after implantation. Results: In 26 patients, the programmed mode was not documented during last follow-up, four patients had died. Of the remaining 106 patients (mean age 58±10, range 34-79 years), 39 were actively delivering therapy with the device, in 14 patients the device was used to monitor the arrhythmia but no shocks were delivered, and in 53 patients it was turned off or explanted. Increases in defibrillation thresholds (n=7), patient intolerance of multiple cardioversion shocks (n=15), and significant bradycardia requiring dual-chamber pacing (n=12) were the main reasons for discontinuation of therapy in addition to battery depletion (n=19). After explantation, efforts to maintain sinus rhythm were continued in 17 patients whereas rate control was attempted in 36 patients. Conclusions: A strategy of maintaining sinus rhythm long-term with an IAD is feasible in a proportion of patients. However, patient selection is critical, and technical improvements (i.e. higher shock energies, dual-chamber pacing and additional preventive and anti-tachycardia pacing algorithms) are required to increase the number of patients having long term benefit, and frequent arrhythmia recurrences and patient intolerance to repeated cardioversion shocks remain a major limitation. © 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology.en_US
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://eurheartj.oxfordjournals.org/en_US
dc.relation.ispartofEuropean Heart Journalen_US
dc.rightsEuropean Heart Journal. Copyright © Oxford University Press.-
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAtrial Fibrillation - Therapyen_US
dc.subject.meshDefibrillators, Implantableen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshRecurrence - Prevention & Controlen_US
dc.subject.meshRetreatmenten_US
dc.subject.meshTime Factorsen_US
dc.subject.meshTreatment Refusalen_US
dc.titleTreatment of atrial fibrillation with an implantable atrial defibrillator - Long term resultsen_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.doi10.1016/j.ehj.2003.09.033en_US
dc.identifier.pmid14643268-
dc.identifier.scopuseid_2-s2.0-10744234011en_US
dc.identifier.hkuros115127-
dc.identifier.hkuros88145-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-10744234011&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume24en_US
dc.identifier.issue23en_US
dc.identifier.spage2083en_US
dc.identifier.epage2089en_US
dc.identifier.isiWOS:000187081500005-
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridGeller, JC=7202179791en_US
dc.identifier.scopusauthoridReeka, S=6504266657en_US
dc.identifier.scopusauthoridTimmermans, C=7006153844en_US
dc.identifier.scopusauthoridKayser, T=36878771100en_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.scopusauthoridWolpert, C=7005239833en_US
dc.identifier.scopusauthoridJung, W=7201622218en_US
dc.identifier.scopusauthoridCamm, AJ=7202602504en_US
dc.identifier.scopusauthoridLau, CP=7401968501en_US
dc.identifier.scopusauthoridWellens, HJJ=35395866600en_US
dc.identifier.scopusauthoridKlein, HU=26642898000en_US

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