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Titolo:
INITIAL CLINICAL-EXPERIENCE WITH AN IMPLANTABLE HUMAN ATRIAL DEFIBRILLATOR
Autore:
LAU CP; TSE HF; LOK NS; LEE KLF; HO DSW; SOPHER M; MURGATROYD F; CAMM AJ;
Indirizzi:
UNIV HONG KONG,QUEEN MARY HOSP,DEPT MED,DIV CARDIOL HONG KONG HONG KONG ST GEORGE HOSP,DEPT CARDIOL LONDON ENGLAND
Titolo Testata:
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
fascicolo: 1, volume: 20, anno: 1997,
parte:, 2
pagine: 220 - 225
SICI:
0147-8389(1997)20:1<220:ICWAIH>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Soggetto:
LOW-ENERGY CARDIOVERSION; INTERNAL CARDIOVERSION; FIBRILLATION; SHEEP;
Keywords:
IMPLANTABLE ATRIAL DEFIBRILLATOR; ATRIAL DEFIBRILLATION; DEFIBRILLATION;
Tipo documento:
Article
Natura:
Periodico
Citazioni:
10
Recensione:
Indirizzi per estratti:
Citazione:
C.P. Lau et al., "INITIAL CLINICAL-EXPERIENCE WITH AN IMPLANTABLE HUMAN ATRIAL DEFIBRILLATOR", PACE, 20(1), 1997, pp. 220-225

Abstract

Low energy biatrial shock is an effective means of restoring sinus rhythm in patients with atrial fibrillation (AF). Ventricular proarrhythmia is avoided provided that shocks are well synchronized to R wave that are not at closely coupled intervals or preceded by long-short cycles. Based on these principles, an implantable atrial defibrillator hasbeen developed and was implanted in three patients with drug refractory paroxysmal AF. The device detects AF via an actively fixed right atrial and a self-retaining coronary sinus defibrillating leads, and delivers 3/3 ms biphasic shocks up to 300 V synchronized to the R wave. The mean implant threshold (ED50) was 195 V (1.8 J), and minimum voltage at conversion during follow-up assessments at 1, 3, and 6 months were 260 V, 2.5 J, 250 V, 2.3 J, and 300 V, 3.0 J respectively. Detectionof AF was 100% specific and shocks were 100% synchronized, although only a proportion of synchronized R waves were considered suitable for shock delivery primarily because of closely coupled cycles. Three patients had 9 spontaneous AF episodes, 8/9 (89%) successfully defibrillated by shocks of 260-300 V. Sedation was not used in 4 out of 9 (45%) episodes. Backup ventricular pacing was initiated by the device in 6 out of (67%) episodes. One patient had more frequent AF after lead placement, which subsided after a change of medication. There was no ventricular proarrhythmia. It is concluded that an implantable atrial defibrillator is a viable therapy for selected patients with paroxysmal AF. The device is capable of accurate AF detection, R wave synchronizationand ventricular support pacing after successful defibrillation of AF.

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Documento generato il 21/09/20 alle ore 12:29:43