RT-184
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Transvenous internal
cardioversion of atrial fibrillation using single and dual pathways simultaneous biphasic
shocks and leads currently used for ventricular defibrillation
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Roberto Neri, Piero Palermo,
Antonio Silvio Cesario, Daniela Baragli, Elisabetta Amici, Maria Teresa Laudadio*, Angelo
De Rosa*, Francesco DeSeta*, Giancarlo Gambelli.
Division of Cardiology, GB Grassi Hospital, Rome, *Medtronic Italia, Italy
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Abstract
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Background. Atrial fibrillation (AF)
often complicates the use of implantable cardioverter defibrillator (ICD) for ventricular
tachy-arrhythmias, while the catastrophe of ventricular fibrillation induction might
result from a poorly synchronized shock delivered by an implanted atrial defibrillator.
Therefore, it seems desiderable to develop a device with the capability for atrial
defibrillation implemented into current ICD systems.
Methods. We evaluated efficacy, safety and tolerability of internal
cardioversion of AF using tilt based (65%) biphasic shocks in two different configurations
tested in random order: 1. right ventricle (RV) to superior vena cava (SVC); 2. RV to
SVC+skin patch in the left prepectoral position. This study included 10 patients (pts)
with a mean age of 66 ± 9 years; AF duration was > 1 month and underlying heart
disease was present in all pts.
Results. AF was terminated in 10/10 pts (100%) with both
configurations. There was no significant difference in delivered energy at the
defibrillation threshold between the two configurations (7.1 ± 5.1 J vs 7.1 ± 2.6 J; p
> 0.05). The addition of the patch significantly reduced the impedance (48 ± 6.1 W vs 57 ± 8.0 W) and increased the
defibrillation current (6.7 ± 1.9 A vs 8.3 ± 1.6 A; p = 0.016).
Conclusions. Low energy cardioversion of chronic AF in pts with heart
disease using current nonthoracotomic lead configurations is a safe, effective and
tolerated under light sedation. The addition of a cutaneous patch did not reduce the
atrial defibrillation threshold and may increase pain perception.
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Key Words
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Atrial fibrillation – transvenous internal
cardioversion
low energy atrial defibrillation, ICD, ICD inappropriate incidences, single/dual pathway
simultaneous biphasic shocks, patch electrode, OA
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