Internal Atrial and Ventricular Defibrillation During Electrophysiology Procedures

  • Fred M. Kusumoto


Over the last twenty years internal defibrillation has evolved from an experimental technique into an important adjunctive procedure in the electrophysiology laboratory. Internal deflbrillation is used for treating persistent atrial fibrillation and refractory ventricular arrhythmias. Atrial defibrillation can be performed with several electrode configurations but generally shocks from 1 to 50 joules are delivered between electrodes placed in the coronary sinus and lateral wall of the right atrium. Ventricular defibrillation is usually performed with electrodes in the right ventricle and superior vena cava, although “unipolar” configurations with an internal ventricular electrode and a skin electrode can be used. Currently, internal deflbrillation can be required in 5–10% of cases within the electrophysiology laboratory and will become more commonly used as electrophysiologists perform more complex catheter ablation procedures.


internal defibrillation electrophysiology study 


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  1. 1.
    Mirowski M, Mower M, Langer AA. Low energy catheter cardioversion of atrial tachyarrhythmias. Clin Res 1974;18:890A (abstract).Google Scholar
  2. 2.
    Lévy S, Lacombe P, Coint R, et al. High energy transcatheter cardioversion of chronic atrial fibrillation. J Am Coll Card 1988;12:514–518.Google Scholar
  3. 3.
    Cooper RA, Johnson EE, Wharton JM. Internal atrial defibrillation in humans. Improved efficacy of biphasic waveforms and the importance of phase duratio. Circulation 1997;1487–1496.Google Scholar
  4. 4.
    Lévy S, Ricard P, Gueunoun M, et al. Low energy cardioversion of spontaneous atrial fibrillation. Immediate and long-term results. Circulation 1997;96:253–259.PubMedGoogle Scholar
  5. 5.
    Tamarasco V, Socas A, Ricard P, Levy S. Internal low-energy cardioversion: A therapeutic option for restoring sinus rhythm in chronic atrial fibrillation after failure of external cardioversion. Europace 1999;1:179–182.CrossRefPubMedGoogle Scholar
  6. 6.
    Boriani G, Biffi M, Camanini C, et al. Transvenous internal cardioversion for atrial fibrillation: A randomized comparison between catheters with different coil length. Am Heart J 2002;144:851–857CrossRefPubMedGoogle Scholar
  7. 7.
    Alt E, Schmitt C, Ammer R, et al. Initial experience with intracardiac atrial defibrillation in patients with chronic atrial fibrillation. PACE 1994;17:1067–1078.PubMedGoogle Scholar
  8. 8.
    Benser ME, Walcott GP, Killingsworth CR, et al. Atrial defibrillation thresholds of electrode configurations available to an atrioventricular defibrillator. J Cardiovasc Electrophysiol 2001;12:957–964.CrossRefPubMedGoogle Scholar
  9. 9.
    Barold HS, Shander G, Tommassoni G, et al. Effect of increased parasympathetic and sympathetic tone on internal atrial defibrillation thresholds in humans. PACE 1999;22:238–242.PubMedGoogle Scholar
  10. 10.
    Mairesse GH, Raepers M, Legrand I, et al. Internal cardioversion of persistent atrial fibrillation using rectilinear biphasic waveform. J Interv Card Electrophysiol 2003;9:371–375.CrossRefPubMedGoogle Scholar
  11. 11.
    Villani G, Piepoli MF, Capucci A. Repoducibility of internal atrial defibrillation threshold in paroxysmal and persistent atrial fibrillation. Europace 2004;6:267–272.CrossRefPubMedGoogle Scholar
  12. 12.
    Tse HF, Lau CP, Ayers GM. Dose-response relationship for successful internal atrial defibrillation. PACE 2003;26:1249–1253.PubMedGoogle Scholar
  13. 13.
    Boriani G, Bartolini P, Biffi M, et al. Atrial signal analysis and defibrillation threshold assessment in chronic persistent and reinduced atrial fibrillation. J Cardiovasc Electrophysiol 2002;13:449–452CrossRefPubMedGoogle Scholar
  14. 14.
    Lok NS, Lau CP, Tang YW. Variation of defibrillation threshold in repeated transvenous atrial defibrillation. PACE 1995;18:850.Google Scholar
  15. 15.
    Kistler PM, Sanders P, Morton JB, et al. Effect of body mass index on defibrillation thresholds for internal cardioversion in patients with atrial fibrillation. Am J Cardiol 2004;94:370–372.CrossRefPubMedGoogle Scholar
  16. 16.
    Sharp JC, Whalley DW. Effectiveness and safety of low-energy internal cardioversion of long-standing atrial fibrillation after unsuccessful exrernal cardioversion. Am J Cardiol 90:657–660.Google Scholar
  17. 17.
    Karch MR, Schmeider S, Ndrepepa G, et al. Internal atrial defibrillation during electrophysiological studies and focal atrial fibrillation ablation procedures. PACE 2001;24:1464–1469.PubMedGoogle Scholar
  18. 18.
    Boriani G, Biffi M, Camanini C, et al. Predictors of atrial defibrillation threshold in internal cardioversion. PACE 2000;23:1898–1901.PubMedGoogle Scholar
  19. 19.
    Efremidis M, Sideris A, Batra R, et al. Facilitating internal cardioversion of chronic atrial fibrillation with ibutilide: Predictors of atrial defibrillation threshold decrease. Med Sci Monit 2004;10:CR258–CR263.PubMedGoogle Scholar
  20. 20.
    Villani GQ, Nollo G, Ravelli F, et al. Capture of atrial fibrillation reduces the atrial defibrillation threshold. PACE 2002;25:1159–1165.PubMedGoogle Scholar
  21. 21.
    Frykman V, Darpo B, Ayers GM. Rapid atrial pacing does not decrease the atrial defibrillation threshold. PACE 2003;26:1461–1466.PubMedGoogle Scholar
  22. 22.
    Steinhaus DM, Cardinal DS, Mongeon L, et al. Internal defibrillation: Pain perception of low energy shocks. PACE 2002;25:1090–1093.PubMedGoogle Scholar
  23. 23.
    Ciccone JM, Saksena S, Shah Y, Pantopoulos D. A prospective randomized study of the clinical efficacy and safety of transvenous cardioversion for termination of ventricular tachycardia. Circulation 1985;71:571–578.PubMedGoogle Scholar
  24. 24.
    Steinhaus DM, Cardinal DS, Mongeon L, et al. Internal defibrillation: Paain perception of low energy shocks. PACE 2002;25:1090–1093.PubMedGoogle Scholar
  25. 25.
    Boriani G, Biffi M, Bronzetti G, et al. Efficacy and tolerability in fully conscious patients of transvenous low energy atrial cardioversion for atrial fibrillation. Am J Cardiol 1998;81:241–244.CrossRefPubMedGoogle Scholar
  26. 26.
    Wathen M, Natale A, Wolfe K, Yee R, Klein G. Initiation of atrial fibrillation in the Wolff Parkinson White syndrome: The importance of the accessory pathway. Am Heart J 1993;125:753–759.CrossRefPubMedGoogle Scholar
  27. 27.
    Kalarus Z, Kowalski O, Lenarczyk R, et al. Electrophysiological features of orthodromic atrioventricular reentry tachycardia in patients with Wolff-Paarkinson-White Syndrome and atrial fibrillation. PACE 2003;26:1479–1488.PubMedGoogle Scholar
  28. 28.
    Lau CP, Tse HF, Ayers GM. Defibrillation guided radiofrequency ablation of atrial fibrillation secondary to an atrial focus. J Am Coll Cardiol 1999;33:1217–1226.CrossRefPubMedGoogle Scholar
  29. 29.
    Häissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659–666.PubMedGoogle Scholar
  30. 30.
    Pappone C, Santinelli V. The who, what, why, and how-to guide for cirumferential pulmonary vein ablation. J Cardiovasc Electrophysiol 15:1226–1230.Google Scholar
  31. 31.
    Häissaguerre M, Sanders P, Hocini M, et al. Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome. Circulation 2004;109:007–13.CrossRefGoogle Scholar
  32. 32.
    Hocini M, Sanders P, Jais P, et al. Techniques for curative treatment of atriaal fibrillation. J Cardiovasc Electrophysiol 2004;15:1467–1471.CrossRefPubMedGoogle Scholar
  33. 33.
    Oral H, Chugh A, Lemola K, et al. Noninducibility of atrial fibrillation as an endpoint of left atrial circumferential ablation for paroxysmal atrial fibrillation. A randomized Study. Circulation 2004;110:2797–2801.CrossRefPubMedGoogle Scholar
  34. 34.
    Callans DJ, Gerstenfeld EP, Dixit A, et al. Efficacy of repeat pulmonary vein isolation procedures in patients with recurrent atrial fibrillation. J Cardiovasc Electrophysiol 2004;15:1050–1055.CrossRefPubMedGoogle Scholar
  35. 35.
    Verma A, Wazni OM, Marrouche NF, et al. Pre-existing left atrial scarring in patients undergoing pulmonary vein antrum isolation. J Am Coll Card 2005;45:285–292.CrossRefGoogle Scholar
  36. 36.
    Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation 2004;109:327–334.CrossRefPubMedGoogle Scholar
  37. 37.
    Gorenek G, Kudaiberdieva O, Goktekin Y, et al. Cardiac biomarkers after internal cardioversion for atrial fibrillation: Detection of myocardial injury. Int J Cardiol 2003;90:115–116.CrossRefPubMedGoogle Scholar
  38. 38.
    Gronefeld GC, Li YG, Bogun F, Hohnloser S. Efficacy and safety of transvenous atrial cardioversion in patients with mitral valve disease and long-standing atrial fibrillation. PACE 2000;23:1894–1897.PubMedGoogle Scholar
  39. 39.
    Tse HF, Lau CP. Bleeding and thromboembolic risks of internal cardioversion for persistent atrial fibrillation. PACE 2002;25:1752–1755.PubMedGoogle Scholar
  40. 40.
    Andraghetti A, Scalese M. Safety and efficacy of low-energy cardioversion of 500 patients using two different techniques. Europace 2001;3:4–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Zipes DP, Jackman WM, Heger JJ, et al. Clinical transvenous cardioversion of recurrent life-threatening ventricular arrhythmias: Low energy synchronized cardioversion of ventricular tachycardia and termination of ventricular fibrillation in patients using a catheter electrode. Am Heart J 1982;103:789–794.CrossRefPubMedGoogle Scholar
  42. 42.
    Waspe LE, Kim S, Matos JA. Role of a catheter lead system for transvenous countershock and pacing during electrophsiologic tests: An assessment of the usefulness of catheter shocks for terminating ventricular tachyarrhythmias. Am J Cardiol 1983;52:477–484.CrossRefPubMedGoogle Scholar
  43. 43.
    Yee R, Zipes DP, Gulamhusen S. Low energy countershock using an intravascular catheter in an acute care setting. Am J Cardiol 1982;50:1124–1129.CrossRefPubMedGoogle Scholar
  44. 44.
    Cohen TJ, Scheinman MM, Pullen BT, et al. Emergency intracardiac defibrillation for refractory ventricular fibrillation during routine electrophysiologic study. J Am Coll Card 1991;18:1280–1184.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Electrophysiology and Pacing Service, Division of Cardiovascular Disease, Department of MedicineMayo ClinicJacksonvilleUSA

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