title: Low energy transvenous cardioversion of short duration atrial tachyarrhythmias in humans using a single lead system.
abstract: The purpose of this study was to investigate the efficacy and safety of atrial cardioversion using an endocardial single lead system presently used for ventricular defibrillation. The study population consisted of 26 recipients of an ICD in combination with a conventional endocardial single lead system with the proximal spring electrode as anode in the SVC and the distal as cathode in the apex of the RV. Atrial tachyarrhythmias were induced by right atrial burst pacing. If the arrhythmia sustained > 1 minute, biphasic shocks synchronized with the R wave were delivered using the implanted device, beginning with an energy of 4 J. If 4 J failed to terminate the arrhythmia, energy was increased stepwise, if the first shock was successful, a step-down testing was performed after reinduction of atrial tachyarrhythmias. The mean atrial defibrillation threshold was 2.3 +/- 1.2 J (range, 0.5-5 J). A total of 154 shocks were delivered and no adverse effects were observed. The mean defibrillation threshold for atrial flutter was somewhat lower than that for AF (1.8 +/- 1 J vs 2.7 +/- 1.4 J, P = 0.08). There was no correlation between the atrial defibrillation threshold and a history of previously occurring atrial tachyarrhythmias, the kind of the underlying heart disease, a prescription of antiarrhythmic drugs, the dimension of the LA, the LVEF, or the ventricular DFT. Internal atrial cardioversion of short duration atrial tachyarrhythmias using a transvenous single lead system designed for ventricular defibrillation is feasible and safe at low energies, and may have important clinical applications.
authors.affiliation: Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Heisel
authors.forename: J
authors.initials: J
authors.lastname: Jung
authors.forename: R
authors.initials: R
authors.lastname: Fries
authors.forename: M
authors.initials: M
authors.lastname: Stopp
authors.forename: S
authors.initials: S
authors.lastname: Sen
authors.forename: H
authors.initials: H
authors.lastname: Schieffer
authors.forename: C
authors.initials: C
authors.lastname: Ozbek
mesh_terms: D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy; D001282:Atrial Flutter / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004554:Electric Countershock / Q000379:methods*; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D012449:Safety; D013015:Sotalol / Q000627:therapeutic use; D013318:Stroke Volume; D013610:Tachycardia / Q000628:therapy*; D016277:Ventricular Function, Left
chemical_list: D000889:Anti-Arrhythmia Agents; D004071:Digitalis Glycosides; D013015:Sotalol; D000638:Amiodarone