title: Atrial fibrillation in patients with a dual defibrillator: characteristics of spontaneous and induced episodes and effect of ventricular tachyarrhythmia induction.
abstract: BACKGROUND
  The pattern of FF intervals during atrial fibrillation (AF) has been analyzed in induced and spontaneous AF episodes, after the induction of ventricular fibrillation (VF) and after atrial shock, in order to suggest practical considerations for AF management in patients implanted with antitachycardia devices.
  
  
  METHODS
  In 13 patients implanted with a dual-chamber defibrillator, FF intervals were analyzed during two separate induced AF episodes, before and after VF induction over AF, as well as during spontaneous AF episodes and after unsuccessful atrial shocks. The following parameters were considered: mean atrial cycle length (CL), atrial CL stability, and standard deviation of the atrial cycle.
  
  
  RESULTS
  The AF pattern had comparable characteristics considering two separate inductions of AF, as well as spontaneous AF episodes. Ventricular tachyarrhythmia induction resulted in a shortening of atrial CL (P < 0.02) and in a less organized AF pattern (P < 0.005). Changes in the FF interval after ineffective shock therapy showed a shortening of AF cycles after shocks with energies far below the defibrillation threshold.
  
  
  CONCLUSIONS
  (a) The AF pattern is reproducible in separate inductions of sustained AF and in spontaneous episodes, (b) dynamic changes involving a shortening of the AF cycle and an evolution to a less homogeneous pattern occur after VF induction, revealing a complex interplay between AF and VF, and (c) FF interval analysis after ineffective shock delivery may allow the relationship between delivered shock energy and effective defibrillation energy to be estimated, thereby providing practical suggestions for step-up protocols in atrial cardioversion.
authors.affiliation: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy. cardio1@med.unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Gianni
authors.initials: G
authors.lastname: Gasparini
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Cinzia
authors.initials: C
authors.lastname: Valzania
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.forename: Andrea
authors.initials: A
authors.lastname: Corrado
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raciti
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D016896:Treatment Outcome