title: Optimization of shocking lead configuration for transvenous atrial defibrillation.
abstract: BACKGROUND
  High atrial defibrillation energy requirements (ADER) in patients with chronic atrial fibrillation (AF) may limit the acceptance of transvenous atrial defibrillation. We evaluated an optimized defibrillation electrode configuration that could help to reduce the ADER in patients with AF.
  
  
  RESULTS
  We tested ten different configurations in nine dogs with AF (3.33+/-2.92 days) induced by rapid atrial pacing. The configurations were: right atrial (RA) appendage as anode and coronary sinus (CS) as cathode; RA and innominate vein (I) as anode to CS (cathode); RA-CS (anode) to I (cathode); I-CS (anode) to RA (cathode); RA and left lateral subcutaneous patch (P) as anode to CS (cathode); RA-CS (anode) to P (cathode); P-CS (anode) to RA (cathode); superior vena cava (SVC) and CS (anode) to RA (cathode); RA-CS (anode) to SVC (cathode); and RA-SVC (anode) to CS (cathode). ADER was defined as the voltage needed to defibrillate the atria in 10% to 90% of 20 consecutive shocks. Three lead systems had ADER lower than the RA (anode) to CS (cathode) configuration, which required a mean of 143+/-58 volts. These three were: RA-SVC (anode) to CS (cathode) 103+/-29 V; I-CS (anode) to RA (cathode) 129+/-39 V; and P-CS (anode) to RA (cathode) 130+/-38 V. The remaining configurations had ADER higher than the RA (anode) to CS (cathode) configuration.
  
  
  CONCLUSIONS
  Adding an additional shocking electrode may reduce ADER when compared with the RA (anode) to CS (cathode) configuration. This concept could be incorporated into future implantable atrial defibrillators or used for refractory patients undergoing temporary transvenous cardioversion.
authors.affiliation: Electrophysiology Laboratory, Sinai Samaritan, Medical Center, Milwaukee, Wisconsin, USA.
authors.forename: D
authors.initials: D
authors.lastname: Krum
authors.forename: J
authors.initials: J
authors.lastname: Hare
authors.forename: K
authors.initials: K
authors.lastname: Mughal
authors.forename: M R
authors.initials: MR
authors.lastname: Jazayeri
authors.forename: S
authors.initials: S
authors.lastname: Deshpande
authors.forename: A
authors.initials: A
authors.lastname: Dhala
authors.forename: Z
authors.initials: Z
authors.lastname: Blanck
authors.forename: M
authors.initials: M
authors.lastname: Akhtar
authors.forename: J
authors.initials: J
authors.lastname: Sra
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000592:standards; D004285:Dogs; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography