title: What is the optimal electrode configuration for atrial defibrillators in man?
abstract: OBJECTIVE
  To compare the atrial defibrillation threshold (DFT) for two electrode configurations in patients with drug refractory persistent atrial fibrillation (AF).
  
  
  RESULTS
  11 patients, 73% male, mean age 60.9 (range 38 to 83), underwent implantation of a Medtronic Jewel AF dual chamber defibrillator (model 7250). A step-up atrial DFT was performed in a randomized sequence for two electrode configurations: (1) Right atrial to distal coronary sinus electrode (RA > CS) and (2) defibrillator can to right ventricular and right atrial electrodes (CAN > RV + RA). The RA > CS configuration restored SR in 10 patients (91%). The CAN > RA + RV configuration restored SR in four patients (36%). The mean atrial DFT was significantly lower for the RA > CS than CAN > RA + RV configuration (10 +/- 7 Joules vs 25 +/- 6 Joules), P < 0.01. At 3 months post implantation, AF was reinduced and the protocol was repeated for the optimal electrode configuration. There was no significant difference in the atrial DFT compared with that at implant.
  
  
  CONCLUSIONS
  The right atrium to coronary sinus electrode configuration significantly reduces the atrial DFT. The atrial DFT also remains stable at 3 months post-implantation. Patients with persistent AF undergoing insertion of an atrial defibrillator should have a coronary sinus electrode implanted.
authors.affiliation: Department of Cardiology, Eastbourne General Hospital, UK. mitcharj@doctors.org.uk
authors.forename: A R J
authors.initials: AR
authors.lastname: Mitchell
authors.forename: P A R
authors.initials: PA
authors.lastname: Spurrell
authors.forename: K
authors.initials: K
authors.lastname: Kamalvand
authors.forename: M
authors.initials: M
authors.lastname: Higson
authors.forename: R
authors.initials: R
authors.lastname: Shanmuganathan
authors.forename: N R
authors.initials: NR
authors.lastname: Patel
authors.forename: N
authors.initials: N
authors.lastname: Sulke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D017147:Defibrillators, Implantable; D004056:Differential Threshold / Q000502:physiology*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged