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- Publisher Website: 10.1111/j.1540-8159.1997.tb04847.x
- Scopus: eid_2-s2.0-0031034508
- PMID: 9121994
- WOS: WOS:A1997WE95700017
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Article: Initial clinical experience with an implantable human atrial defibrillator
Title | Initial clinical experience with an implantable human atrial defibrillator |
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Authors | |
Keywords | atrial fibrillation defibrillation implantable atrial defibrillator |
Issue Date | 1997 |
Publisher | Wiley-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? |
Abstract | Low 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 Identifier | http://hdl.handle.net/10722/76564 |
ISSN | 2023 Impact Factor: 1.7 2023 SCImago Journal Rankings: 0.579 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Lau, CP | en_HK |
dc.contributor.author | Tse, HF | en_HK |
dc.contributor.author | Lok, NS | en_HK |
dc.contributor.author | Lee, KLF | en_HK |
dc.contributor.author | Ho, DSW | en_HK |
dc.contributor.author | Sopher, M | en_HK |
dc.contributor.author | Murgatroyd, F | en_HK |
dc.contributor.author | Camm, AJ | en_HK |
dc.date.accessioned | 2010-09-06T07:22:35Z | - |
dc.date.available | 2010-09-06T07:22:35Z | - |
dc.date.issued | 1997 | en_HK |
dc.identifier.citation | Pace - Pacing And Clinical Electrophysiology, 1997, v. 20 n. 1 SUPPL., p. 220-225 | en_HK |
dc.identifier.issn | 0147-8389 | en_HK |
dc.identifier.uri | http://hdl.handle.net/10722/76564 | - |
dc.description.abstract | Low 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.language | eng | en_HK |
dc.publisher | Wiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1 | en_HK |
dc.relation.ispartof | PACE - Pacing and Clinical Electrophysiology | en_HK |
dc.subject | atrial fibrillation | - |
dc.subject | defibrillation | - |
dc.subject | implantable atrial defibrillator | - |
dc.subject.mesh | Adult | en_HK |
dc.subject.mesh | Aged | en_HK |
dc.subject.mesh | Anti-Arrhythmia Agents - therapeutic use | en_HK |
dc.subject.mesh | Arrhythmias, Cardiac - prevention & control | en_HK |
dc.subject.mesh | Atrial Fibrillation - therapy | en_HK |
dc.subject.mesh | Cardiac Pacing, Artificial | en_HK |
dc.subject.mesh | Conscious Sedation | en_HK |
dc.subject.mesh | Defibrillators, Implantable - adverse effects - classification | en_HK |
dc.subject.mesh | Electric Conductivity | en_HK |
dc.subject.mesh | Electric Countershock - methods | en_HK |
dc.subject.mesh | Electrocardiography | en_HK |
dc.subject.mesh | Follow-Up Studies | en_HK |
dc.subject.mesh | Heart Atria | en_HK |
dc.subject.mesh | Heart Ventricles | en_HK |
dc.subject.mesh | Hematoma - etiology | en_HK |
dc.subject.mesh | Humans | en_HK |
dc.subject.mesh | Middle Aged | en_HK |
dc.subject.mesh | Muscular Diseases - etiology | en_HK |
dc.subject.mesh | Pectoralis Muscles - surgery | en_HK |
dc.subject.mesh | Sensitivity and Specificity | en_HK |
dc.subject.mesh | Sotalol - therapeutic use | en_HK |
dc.title | Initial clinical experience with an implantable human atrial defibrillator | en_HK |
dc.type | Article | en_HK |
dc.identifier.openurl | http://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+defibrillator | en_HK |
dc.identifier.email | Tse, HF:hftse@hkucc.hku.hk | en_HK |
dc.identifier.authority | Tse, HF=rp00428 | en_HK |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1111/j.1540-8159.1997.tb04847.x | en_HK |
dc.identifier.pmid | 9121994 | - |
dc.identifier.scopus | eid_2-s2.0-0031034508 | en_HK |
dc.identifier.hkuros | 22971 | en_HK |
dc.identifier.hkuros | 40402 | - |
dc.identifier.volume | 20 | en_HK |
dc.identifier.issue | 1 SUPPL. | en_HK |
dc.identifier.spage | 220 | en_HK |
dc.identifier.epage | 225 | en_HK |
dc.identifier.isi | WOS:A1997WE95700017 | - |
dc.publisher.place | United States | en_HK |
dc.identifier.scopusauthorid | Lau, CP=7401968501 | en_HK |
dc.identifier.scopusauthorid | Tse, HF=7006070805 | en_HK |
dc.identifier.scopusauthorid | Lok, NS=6506301563 | en_HK |
dc.identifier.scopusauthorid | Lee, KLF=7501505962 | en_HK |
dc.identifier.scopusauthorid | Ho, DSW=7402970193 | en_HK |
dc.identifier.scopusauthorid | Sopher, M=8292497200 | en_HK |
dc.identifier.scopusauthorid | Murgatroyd, F=7003946169 | en_HK |
dc.identifier.scopusauthorid | Camm, AJ=7202602504 | en_HK |
dc.identifier.issnl | 0147-8389 | - |