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Article: Clinical shock tolerability and effect of different right atrial electrode locations on efficacy of low energy human transvenous atrial defibrillation using an implantable lead system

TitleClinical shock tolerability and effect of different right atrial electrode locations on efficacy of low energy human transvenous atrial defibrillation using an implantable lead system
Authors
Issue Date1997
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jac
Citation
Journal Of The American College Of Cardiology, 1997, v. 30 n. 5, p. 1324-1330 How to Cite?
AbstractObjectives. The objectives of this study were 1) to evaluate the effect of different right atrial electrode locations on the efficacy of low energy transvenous defibrillation with an implantable lead system; and 2) to qualitate and quantify the discomfort from atrial defibrillation shocks delivered by a clinically relevant method. Background. Biatrial shocks result in the lowest thresholds for transvenous atrial defibrillation, but the optimal right atrial and coronary sinus electrode locations for defibrillation efficacy in humans have not been defined. Methods. Twenty- eight patients (17 men, 11 women) with chronic atrial fibrillation (AF) (lasting ≤1 month) were studied. Transvenous atrial defibrillation was performed by delivering R wave-synchronized biphasic shocks with incremental shock levels (from 180 to 400 V in steps of 40 V). Different electrode location combinations were used and tested randomly: the anterolateral, inferomedial right atrium or high right atrial appendage to the distal coronary sinus. Defibrillation thresholds were defined in duplicate by using the step-up protocol. Pain perception of shock delivery was assessed by using a purpose-designed questionnaire; sedation was given when the shock level was unacceptable (tolerability threshold). Results. Sinus rhythm was restored in 26 of 28 patients by using at least one of the right atrial electrode locations tested. The conversion rate with the anterolateral right atrial location (21 [81%] of 26) was higher than that with the inferomedial right atrial location (8 [50%] of 16, p < 0.05) but similar to that with the high right atrial appendage location (16 [89%] of 18, p > 0.05). The mean defibrillation thresholds for the high right atrial appendage, anterolateral right atrium and inferomedial right atrium were all significantly different with respect to energy (3.9 ± 1.8 J vs. 4.6 ± 1.8 J vs. 6.0 ± 1.7 J, respectively, p < 0.05) and voltage (317 ± 77 V vs. 348 ± 70 V vs. 396 ± 66 V, respectively, p < 0.05). Patients tolerated a mean of 3.4 ± 2 shocks with a tolerability threshold of 255 ± 60 V, 2.5 ± 1.3 J. Conclusions. Low energy, transvenous defibrillation with an implantable defibrillation lead system is an effective treatment for AF. Most patients can tolerate two to three shocks, and, when the staffing shock level (189 V) is close to the defibrillation threshold, they can tolerate on average a shock level of 260 V without sedation. Electrodes should be positioned in the distal coronary sinus and in the high right atrial appendage to achieve the lowest defibrillation threshold, although other locations may be suitable for certain patients.
Persistent Identifierhttp://hdl.handle.net/10722/77385
ISSN
2015 Impact Factor: 17.759
2015 SCImago Journal Rankings: 10.097
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLok, NSen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorTse, HFen_HK
dc.contributor.authorAyers, GMen_HK
dc.date.accessioned2010-09-06T07:31:20Z-
dc.date.available2010-09-06T07:31:20Z-
dc.date.issued1997en_HK
dc.identifier.citationJournal Of The American College Of Cardiology, 1997, v. 30 n. 5, p. 1324-1330en_HK
dc.identifier.issn0735-1097en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77385-
dc.description.abstractObjectives. The objectives of this study were 1) to evaluate the effect of different right atrial electrode locations on the efficacy of low energy transvenous defibrillation with an implantable lead system; and 2) to qualitate and quantify the discomfort from atrial defibrillation shocks delivered by a clinically relevant method. Background. Biatrial shocks result in the lowest thresholds for transvenous atrial defibrillation, but the optimal right atrial and coronary sinus electrode locations for defibrillation efficacy in humans have not been defined. Methods. Twenty- eight patients (17 men, 11 women) with chronic atrial fibrillation (AF) (lasting ≤1 month) were studied. Transvenous atrial defibrillation was performed by delivering R wave-synchronized biphasic shocks with incremental shock levels (from 180 to 400 V in steps of 40 V). Different electrode location combinations were used and tested randomly: the anterolateral, inferomedial right atrium or high right atrial appendage to the distal coronary sinus. Defibrillation thresholds were defined in duplicate by using the step-up protocol. Pain perception of shock delivery was assessed by using a purpose-designed questionnaire; sedation was given when the shock level was unacceptable (tolerability threshold). Results. Sinus rhythm was restored in 26 of 28 patients by using at least one of the right atrial electrode locations tested. The conversion rate with the anterolateral right atrial location (21 [81%] of 26) was higher than that with the inferomedial right atrial location (8 [50%] of 16, p < 0.05) but similar to that with the high right atrial appendage location (16 [89%] of 18, p > 0.05). The mean defibrillation thresholds for the high right atrial appendage, anterolateral right atrium and inferomedial right atrium were all significantly different with respect to energy (3.9 ± 1.8 J vs. 4.6 ± 1.8 J vs. 6.0 ± 1.7 J, respectively, p < 0.05) and voltage (317 ± 77 V vs. 348 ± 70 V vs. 396 ± 66 V, respectively, p < 0.05). Patients tolerated a mean of 3.4 ± 2 shocks with a tolerability threshold of 255 ± 60 V, 2.5 ± 1.3 J. Conclusions. Low energy, transvenous defibrillation with an implantable defibrillation lead system is an effective treatment for AF. Most patients can tolerate two to three shocks, and, when the staffing shock level (189 V) is close to the defibrillation threshold, they can tolerate on average a shock level of 260 V without sedation. Electrodes should be positioned in the distal coronary sinus and in the high right atrial appendage to achieve the lowest defibrillation threshold, although other locations may be suitable for certain patients.en_HK
dc.languageengen_HK
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jacen_HK
dc.relation.ispartofJournal of the American College of Cardiologyen_HK
dc.rightsJournal of American College of Cardiology. Copyright © Elsevier Inc.en_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAged, 80 and overen_HK
dc.subject.meshAtrial Fibrillation - therapyen_HK
dc.subject.meshElectric Countershocken_HK
dc.subject.meshElectrodes, Implanteden_HK
dc.subject.meshElectroshocken_HK
dc.subject.meshEvaluation Studies as Topicen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleClinical shock tolerability and effect of different right atrial electrode locations on efficacy of low energy human transvenous atrial defibrillation using an implantable lead systemen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0735-1097&volume=30 &issue=5&spage=1324&epage=1330&date=1997&atitle=Clinical+shock+tolerability+and+effect+of+different+right+atrial+electrode+locations+on+efficacy+of+low+energy+human+transvenous+atrial+defibrillation+using+an+implantable+lead+systemen_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S0735-1097(97)00298-2en_HK
dc.identifier.pmid9350935-
dc.identifier.scopuseid_2-s2.0-0030784905en_HK
dc.identifier.hkuros39286en_HK
dc.identifier.hkuros37184-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0030784905&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume30en_HK
dc.identifier.issue5en_HK
dc.identifier.spage1324en_HK
dc.identifier.epage1330en_HK
dc.identifier.isiWOS:A1997YD80200028-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLok, NS=6506301563en_HK
dc.identifier.scopusauthoridLau, CP=35275317200en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridAyers, GM=7102015157en_HK

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