title: Importance of electrode design, lead configuration and impedance for successful low energy transcatheter atrial defibrillation in dogs.
abstract: OBJECTIVE
  We assessed the feasibility of low energy endocardial defibrillation in a canine model of atrial fibrillation, comparing catheters with large surface area electrodes and standard electrode catheters, and evaluated the effects of lead configuration and circuit impedance on defibrillation energy requirements.
  
  
  BACKGROUND
  Although recent animal studies have demonstrated the feasibility of low energy endocardial atrial defibrillation, their results have been conflicting with regard to important methodologic aspects.
  
  
  METHODS
  In 14 anesthetized greyhounds, atrial fibrillation was induced by rapid atrial pacing and maintained by vagal stimulation. Two large surface area braided electrode catheters and two standard electrode catheters were introduced percutaneously, one of each, in the right atrial appendage and right ventricular apex. A cutaneous patch electrode was placed on the left thorax. Biphasic shocks synchronized to the ventricular electrogram were used to terminate atrial fibrillation. Seven configurations were evaluated. Three used standard electrodes: proximal atrial cathode to distal atrial, ventricular or cutaneous anode. Four used braided electrodes: three with atrial cathode to ventricular, cutaneous or combined anode; one with ventricular cathode to atrial anode.
  
  
  RESULTS
  Defibrillation with standard electrode catheters was associated with high impedance (576 +/- 112 omega) and low success rates for all configurations (28% success at < or = 40 J, no successes at 10 J). Low energy defibrillation was readily achieved with the braided electrodes with significantly lower impedance (75 +/- 13 omega, p < 0.0001). Ventricular fibrillation did not occur. The success rate of cardioversion increased in a dose-response manner, allowing fitting of a sigmoid curve and calculation of energy associated with 50% (ED50) and 90% (ED90) success. The most successful configuration was ventricular cathode/atrial anode (ED50 1.5 +/- 0.4 J), and the least successful was atrial anode/cutaneous patch (ED50 6.5 +/- 3.2 J, p = 0.0001).
  
  
  CONCLUSIONS
  Low energy atrial defibrillation is feasible using large surface area electrodes but not with standard electrode catheters owing to high impedance. An intracardiac anode provides lower impedance and higher success rates than are provided by a cutaneous anode.
authors.affiliation: Department of Cardiology, Austin Hospital, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Kalman
authors.forename: J M
authors.initials: JM
authors.lastname: Power
authors.forename: J M
authors.initials: JM
authors.lastname: Chen
authors.forename: S J
authors.initials: SJ
authors.lastname: Farish
authors.forename: A M
authors.initials: AM
authors.lastname: Tonkin
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001281:Atrial Fibrillation / Q000473:pathology / Q000628:therapy*; D004195:Disease Models, Animal; D004285:Dogs; D004554:Electric Countershock / Q000295:instrumentation*; D017097:Electric Impedance; D004562:Electrocardiography; D004567:Electrodes, Implanted / Q000592:standards*; D004699:Endocardium; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D016013:Likelihood Functions; D016015:Logistic Models