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Article: Initial clinical experience with an implantable human atrial defibrillator

TitleInitial clinical experience with an implantable human atrial defibrillator
Authors
Issue Date1997
PublisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1
Citation
Pace - Pacing And Clinical Electrophysiology, 1997, v. 20 n. 1 SUPPL., p. 220-225 How to Cite?
AbstractLow energy biatrial shock is an effective means of restoring sinus rhythm in patients with atrial fibrillation (AF). Ventricular proarrythmia is avoided provided that shocks are well synchronized to R waves that are not at closely coupled intervals or preceded by long-short cycles. Based on these principles, an implantable atrial defibrillator has been developed and was implanted in three patients with drug refractory paroxysmal AF. The device detects AF via an actively fixed right atrial and a self-retaining coronary sinus defibrillating leads, and delivers 3/3 ms biphasic shocks up to 300 V synchronized to the B wave. The mean implant threshold (ED50) was 195V (1.8 J), and minimum voltage at conversion during follow-up assessments at 1, 3, and 6 months were 260 V, 2.5 J. 250 V, 2.3 J, and 300 V, 3.0 J respectively. Detection of AF was 100% specific and shocks were 100% synchronized, although only a proportion of synchronized R waves were considered suitable for shock delivery primarily because of closely coupled cycles. Three patients had 9 spontaneous AF episodes, 8/9 (89%) successfully defibrillated by shocks of 260-300 V. Sedation was not used in 4 out of 9 (45%) episodes. Backup ventricular pacing was initiated by the device in 6 out of (67%) episodes. One patient had more frequent AF after lead placement, which subsided after a change of medication. There was no ventricular proarrhythmia. It is concluded that an implantable atrial defibrillator is a viable therapy for selected patients with paroxysmal AF. The device is capable of accurate AF detection, R wave synchronization and ventricular support pacing after successful defibrilation of AF.
Persistent Identifierhttp://hdl.handle.net/10722/76564
ISSN
2015 Impact Factor: 1.156
2015 SCImago Journal Rankings: 0.662
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLau, CPen_HK
dc.contributor.authorTse, HFen_HK
dc.contributor.authorLok, NSen_HK
dc.contributor.authorLee, KLFen_HK
dc.contributor.authorHo, DSWen_HK
dc.contributor.authorSopher, Men_HK
dc.contributor.authorMurgatroyd, Fen_HK
dc.contributor.authorCamm, AJen_HK
dc.date.accessioned2010-09-06T07:22:35Z-
dc.date.available2010-09-06T07:22:35Z-
dc.date.issued1997en_HK
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 1997, v. 20 n. 1 SUPPL., p. 220-225en_HK
dc.identifier.issn0147-8389en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76564-
dc.description.abstractLow energy biatrial shock is an effective means of restoring sinus rhythm in patients with atrial fibrillation (AF). Ventricular proarrythmia is avoided provided that shocks are well synchronized to R waves that are not at closely coupled intervals or preceded by long-short cycles. Based on these principles, an implantable atrial defibrillator has been developed and was implanted in three patients with drug refractory paroxysmal AF. The device detects AF via an actively fixed right atrial and a self-retaining coronary sinus defibrillating leads, and delivers 3/3 ms biphasic shocks up to 300 V synchronized to the B wave. The mean implant threshold (ED50) was 195V (1.8 J), and minimum voltage at conversion during follow-up assessments at 1, 3, and 6 months were 260 V, 2.5 J. 250 V, 2.3 J, and 300 V, 3.0 J respectively. Detection of AF was 100% specific and shocks were 100% synchronized, although only a proportion of synchronized R waves were considered suitable for shock delivery primarily because of closely coupled cycles. Three patients had 9 spontaneous AF episodes, 8/9 (89%) successfully defibrillated by shocks of 260-300 V. Sedation was not used in 4 out of 9 (45%) episodes. Backup ventricular pacing was initiated by the device in 6 out of (67%) episodes. One patient had more frequent AF after lead placement, which subsided after a change of medication. There was no ventricular proarrhythmia. It is concluded that an implantable atrial defibrillator is a viable therapy for selected patients with paroxysmal AF. The device is capable of accurate AF detection, R wave synchronization and ventricular support pacing after successful defibrilation of AF.en_HK
dc.languageengen_HK
dc.publisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1en_HK
dc.relation.ispartofPACE - Pacing and Clinical Electrophysiologyen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAnti-Arrhythmia Agents - therapeutic useen_HK
dc.subject.meshArrhythmias, Cardiac - prevention & controlen_HK
dc.subject.meshAtrial Fibrillation - therapyen_HK
dc.subject.meshCardiac Pacing, Artificialen_HK
dc.subject.meshConscious Sedationen_HK
dc.subject.meshDefibrillators, Implantable - adverse effects - classificationen_HK
dc.subject.meshElectric Conductivityen_HK
dc.subject.meshElectric Countershock - methodsen_HK
dc.subject.meshElectrocardiographyen_HK
dc.subject.meshFollow-Up Studiesen_HK
dc.subject.meshHeart Atriaen_HK
dc.subject.meshHeart Ventriclesen_HK
dc.subject.meshHematoma - etiologyen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshMuscular Diseases - etiologyen_HK
dc.subject.meshPectoralis Muscles - surgeryen_HK
dc.subject.meshSensitivity and Specificityen_HK
dc.subject.meshSotalol - therapeutic useen_HK
dc.titleInitial clinical experience with an implantable human atrial defibrillatoren_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0147-8389&volume=&spage=&epage=&date=1997&atitle=Initial+clinical+experience+with+an+implantable+human+atrial+defibrillatoren_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1540-8159.1997.tb04847.xen_HK
dc.identifier.pmid9121994-
dc.identifier.scopuseid_2-s2.0-0031034508en_HK
dc.identifier.hkuros22971en_HK
dc.identifier.hkuros40402-
dc.identifier.volume20en_HK
dc.identifier.issue1 SUPPL.en_HK
dc.identifier.spage220en_HK
dc.identifier.epage225en_HK
dc.identifier.isiWOS:A1997WE95700017-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridLok, NS=6506301563en_HK
dc.identifier.scopusauthoridLee, KLF=7501505962en_HK
dc.identifier.scopusauthoridHo, DSW=7402970193en_HK
dc.identifier.scopusauthoridSopher, M=8292497200en_HK
dc.identifier.scopusauthoridMurgatroyd, F=7003946169en_HK
dc.identifier.scopusauthoridCamm, AJ=7202602504en_HK

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