Optimization of Shocking Lead Configuration for Transvenous Atrial Defibrillation |
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Authors: | DAVID KRUM M.S. JOHN HARE B.S. KASHEF MUGHAL B.S. MOHAMMAD R. JAZAYERI M.D. SANJAY DESHPANDE M.D. ANWER DHALA M.D. ZALMEN BLANCK M.D. MASOOD AKHTAR M.D. JASBIR SRA M.D. |
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Affiliation: | Electrophysiology Laboratories, Sinai Samaritan and St. Luke's Medical Centers, Milwaukee, Wisconsin |
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Abstract: | Optimum Electrodes for Atrial Defibrillation. Introduction : 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 ADKR in patients with AF. Methods and 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 und 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. Conclusion : Adding an additional shocking electrode may reduce ADER when compared with the RA (anode) to CS (cathode) configuration. This concept could he incorporated into future implantable atrial defibrillators or used for refractory patients undergoing temporary transvenous cardioversion. |
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Keywords: | atrial fibrillation atrial defibrillation implantable atrial defibrillator leads lead configuration |
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