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Design Concepts for Implantable Atrial Defibrillators

  • Chapter
Cardiac Arrhythmias, Pacing & Electrophysiology

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 201))

  • 176 Accesses

Abstract

Atrial fibrillation is an arrhythmia characterised by disorganised atrial depolarisations resulting in uncoordinated atrial activity, a reduction in cardiac output, and a number of other significant health risks. There are three possible therapeutic goals to consider for patients with atrial fibrillation: control of ventricular rate, maintenance of sinus rhythm, and prevention of thromboembolism1. Present treatments for atrial fibrillation include drug therapy, ablation and pacing, and external cardioversion. All of these treatments vary in their method, invasiveness, and therapeutic goal. Recent studies have shown that a new technique of low-energy internal cardioversion with temporary leads is a feasible and effective method for restoring sinus rhythm2–4. Given the recurrent nature of atrial fibrillation, the promising results with low-energy internal cardioversion, and the present state of implantable device technology and application, the possibility has been raised for the development of an implantable atrial defibrillator. Levy and Camm discussed the basic requirements for an implantable atrial defibrillator in an editorial examining the feasibility of such a devices5. The authors concluded that safety, efficacy, and tolerability were the main concerns in developing a device to terminate atrial fibrillation. Design concepts should,therefore, incorporate these concerns. This chapter will specifically address these criteria in the context of the present status of basic research and clinical experience.

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References

  1. Prystowsky EN, Benson DW Jr, Fuster V et al. Management of patients with atrial fibrillation. Circulation 1996; 93: 1262–77.

    Article  PubMed  CAS  Google Scholar 

  2. Levy S, Ricard P, Lau CP, et al. Multicenter low energy transvenous atrial defibrillation (XAD) trial results in different subsets of atrial fibrillation. J Am Coll Cardiol 1997; 29: 750–5.

    Article  PubMed  CAS  Google Scholar 

  3. Lok NS, Lau CP, Tang YW, Ho Sai Wah D. Effect of sotalol on transvenous atrial defibrillation for acute and chronic atrial fibrillation. J Am Coll Cardiol 1995; 25: 109A (abstract).

    Google Scholar 

  4. Murgatroyd FD, Slade AKB, Sopher SM, Rowland E, Ward DE, Camm AJ. Efficacy and tolerability of trans-venous low energy cardioversion of paroxysmal atrial fibrillation in humans. J Am Coll Cardiol 1995; 25: 1347–53.

    Article  PubMed  CAS  Google Scholar 

  5. Levy S, Camm J. An implantable defibrillator: an impossible dream [editorial]? Circulation 1993; 87: 1769–72.

    Article  PubMed  CAS  Google Scholar 

  6. Bialy D, Lehmann MH, Schumacher DN, Steinman RT, Meissner MD. Hospitalization for arrhythmias in the United States: importance of atrial fibrillation. J Am Coll Cardiol 1992; 19: 41A (abstract).

    Google Scholar 

  7. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation. N Engl J Med 1982; 306: 1018–22.

    Article  PubMed  CAS  Google Scholar 

  8. Cobbe, SM. Incidence and risks associated with atrial fibrillation. PACE 1994; 17: 1005–10.

    Article  PubMed  CAS  Google Scholar 

  9. Fiaker GC, Blackshear JL, McBride R, Kronmal RA, Halperin JL, Hart RG. Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. J Am Coll Cardiol 1992; 20: 527–32.

    Article  Google Scholar 

  10. Cox JL, Boineau JP, Schuessler RB et al. Successful surgical treatment of atrial fibrillation. J Am Coll Cardiol 1991; 266: 1976–80.

    CAS  Google Scholar 

  11. Lown B, Perlroth MG, Kaidbey S, Tadaaki A, Harken DE. “Cardioversion” of atrial fibrillation. N Engl J Med 1963; 269: 325–31.

    Article  PubMed  CAS  Google Scholar 

  12. Levy S, Lauribe P, Dolla E et al. A randomized comparison of external and internal cardioversion of chronic atrial fibrillation. Circulation 1992; 86: 1415–20.

    Article  PubMed  CAS  Google Scholar 

  13. Alt E, Schmitt C, Ammer R et al. Effect of electrode position on outcome of low-energy intracardiaccardioversion of atrial fibrillation. Am J Cardiol 1997; 79: 621–5.

    Google Scholar 

  14. Dunbar DN, Tobler HG, Fetter J, Gornick CC, Benson DW Jr, Benditt DG. Intracavitary electrode catheter cardioversion of atrial tachyarrhythmias in the dog. J Am Coil Cardiol 1986; 7: 1015–27.

    Article  CAS  Google Scholar 

  15. Cooper RAS, Alferness CA, Smith WM, Ideker RE. Internal cardioversion of atrial fibrillation in sheep. Circulation 1993; 87: 1673–86.

    Article  PubMed  CAS  Google Scholar 

  16. Adams JM, Ayers GM, Infinger KR, Bocek JM, White HG, Alferness CA. Preceding ventricular interval: a programmed criterion for an implantable atrial defibrillator. Am Heart J 1994; 128: 636 (abstract).

    Google Scholar 

  17. Murgatroyd FD, Johnson EE, Cooper RA et al. Safety of low energy transvenous atrial defibrillation-world experience. Circulation 1995; 90: I - 14 (abstract).

    Google Scholar 

  18. Lau CP, Tse HF, Lee K et al. Initial clinical experience of an human implantable atrial defibrillator. PACE 1996; 19: 625 (abstract).

    Google Scholar 

  19. Ayers GM, Alferness CA, Ilina M et al. Ventricular proarrhythmic effects of ventricular cycle length and shock strength in a sheep model of transvenous atrial defibrillation. Circulation 1994; 89: 413–22.

    Article  PubMed  CAS  Google Scholar 

  20. Keelan ET, Krum D, Hare J et al. The safety of atrial defibrillation in the presence of bundle branch block: a proposal for new criteria. J Am Coll Cardiol 1996; 27: 312A (abstract).

    Google Scholar 

  21. Li H, Hare J, Mughal K et al. Safety of atrial defibrillation: the importance of pre-shock R-R intervals and the risk of premature ventricular contractions. J Am Coll Cardiol 1997; 27: 301A (abstract).

    Google Scholar 

  22. Sra J, Wharton M, Biblo L for the Metrix System External Study Investigators. Feasibility of MetrixTM atrial defibrillation system in humans with atrial fibrillation. J Am Coll Cardiol 1996; 27: 375A (abstract).

    Google Scholar 

  23. Saksena S, Prakash A, Mangeon L et al. Clinical efficacy and safety of atrial defibrillation using biphasic shocks and current nonthoracotomy endocardial lead configurations. Am J Cardiol 1995; 76: 913–21 (abstract).

    Article  PubMed  CAS  Google Scholar 

  24. Sra J, Maglio C, Chen V, et al. Atrial fibrillation detection in humans using the MetrixTM atrial defibrillation system. J Am Coll Cardiol 1996; 27: 375A (abstract).

    Google Scholar 

  25. Tse HF, Lau CP, Adler S, Kim J. The efficacy for atrial fibrillation detection and R-wave synchronization for shock delivery in patients with implantable human atrial defibrillator. Circulation I996;94:I-67 (abstract).

    Google Scholar 

  26. Winkle RA, Mead RH, Ruder MA et al. Improved low energy defibrillation efficacy in man with the use of a biphasic truncated exponential waveform. Am Heart J 1989; 117: 122–7.

    Article  PubMed  CAS  Google Scholar 

  27. Troup P, Chapman P, Wetherbee J et al. Improved internal defibrillation efficacy in patients with biphasic shocks. J Am Coll Cardiol 1988; 11: 209A (abstract).

    Google Scholar 

  28. Johnson EE, Yarger MD, Wharton JM. Monophasic and biphasic waveforms for low energy interval cardioversion of atrial fibrillation in humans. Circulation 1993; 88: I - 592 (abstract).

    Google Scholar 

  29. Cooper RAS, Johnson EE, Wharton JM. The improved efficacy of asymmetric biphasic waveforms for internal cardioversion of atrial fibrillation in humans. PACE 1995; 18: 896 (abstract).

    Article  Google Scholar 

  30. Schmitt C, Ammer R, Plewan A, Karch M, Evans F. Energy requirements for intracardiac low-energy cardioversion of chronic atrial fibrillation: comparison of different lead positions. Circulation 1995; 92: I - 473 (abstract).

    Google Scholar 

  31. Ayers G, Mina M, Wagner D, Kreyenhagen P, Bernard S, Alferness C. Cardiac vein electrode location for trans-venous atrial defibrillation. J Am Coll Cardiol 1993; 21: 306A (abstract).

    Google Scholar 

  32. Ayers GM, Ilina ML, Wagner DO, Sirokman WA, Griffin JC, Alferness CA. Right atrial electrode location for transvenous atrial defibrillation. J Am Coll Cardiol 1994; 23: 125A (abstract).

    Google Scholar 

  33. Lok NS, Lau CP, Lee KLF, Tse HF, Ayers GM. Effect of different right atrial lead locations on the efficacy and tolerability of low energy transvenous atrial defibrillation with an implantable lead system. PACE 1996; 19: 633 (abstract).

    Google Scholar 

  34. Levy S, Ricard P, Gueunoun M, Trigano J, Saadjian A, Paganelli F. Low energy internal cardioversion of spontaneous atrial fibrillation. PACE 1995; 18: 1120 (abstract).

    Google Scholar 

  35. Levy S, Ricard P, Lau CP et al. Multicenter low energy transvenous atrial defibrillation (XAD) trial. Circulation 1995; 92: I - 472 (abstract).

    Article  Google Scholar 

  36. Lau CP, Tse HF, Jung W et al. Safety and efficacy of an human implantable defibrillator for atrial fibrillation. Circulation 1996; 94: I - 562 (abstract).

    Google Scholar 

  37. Alt E, Ammer R, Schmitt C, Pasquantonia J, Evans F. Repeated internal low-energy cardioversion of atrial fibrillation. J Am Coll Cardiol 1996; 27: 302A (abstract).

    Google Scholar 

  38. Weigner MJ, Caulfield TA, Danias PG, Silverman DI, Manning WJ. Safety of early cardioversion for patients with atrial fibrillation 48 hours. Circulation 1996; 94:1–72 (abstract).

    Google Scholar 

  39. Ayers GM, Gonzalez X, Mina MB, Wagner DO, Sirokman WA, Alferness CA. Maturation of an atrial defibrillation lead system causes no change in threshold. J Am Coll Cardiol 1995; 25: 109A (abstract).

    Google Scholar 

  40. Ayers GM, Gonzalez X, Ilina MB, Wagner DO, Sirokman WA, Alferness CA. Defibrillation and sensing characteristics of a chronically implanted atrial defibrillation lead system. PACE 1995; 18: 901 (abstract).

    Google Scholar 

  41. Harbinson MT, Imam Z, McEneaney DJ et al. Patient discomfort after transvenous catheter cardioversion of atrial tachyarrhythmias with rounded waveforms-initial results. Circulation 1996; 94: 1–67 (abstract).

    Article  Google Scholar 

  42. Alt E, Ammer R, Schmitt C et al. Pain threshold for internal cardioversion with low or no sedation. PACE 1996; 19: 737 (abstract).

    Google Scholar 

  43. Ammer R, Alt E, Lehmann G et al. Pain threshold for internal cardioversion with low or no sedation. J Am Coll Cardiol 1997; 29: 113A (abstract).

    Google Scholar 

  44. Gonzalez X, Ayers GM, Wagner DO, Ilina MB, Sirokman WA, Alferness CA. Waveforms to reduce peak voltages for internal atrial defibrillation. PACE 1996; 19: 696 (abstract).

    Google Scholar 

  45. Harbinson M, Trouton T, Imam Z et al. Transvenous catheter atrial defibrillation using rounded vs. standard biphasic waveforms. PACE 1996; 19: 696 (abstract).

    Google Scholar 

  46. Harbinson MT, Allen JD, Imam Z et al. Rounded biphasic waveform reduces energy requirements for transvenous catheter cardioversion of atrial fibrillation and flutter. PACE 1997; 20: 226–9.

    Article  PubMed  CAS  Google Scholar 

  47. Lok NS, Lau CP, Ayers GM. Can transvenous atrial defibrillation be performed without sedation [abstract]? Eur J Cardiac Pacing Electrophysiol 1996; 6: 55.

    Google Scholar 

  48. Ayers GM, Griffin JC. The future role of defibrillators in the management of atrial fibrillation. In: Current Opinion in Cardiology. Rapid Science Publishers; 1997; 12: 12–17.

    Google Scholar 

  49. Levy S, Richard P. Is there any indication for an intracardiac defibrillator for the treatment of atrial fibrillation? J Cardiovasc Electrophysiol 1994; 5: 982–5.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Carolyn K. Wiemers
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  2. Gregory M. Ayers
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Editor information

Editors and Affiliations

  1. Medical School, University of Crete, Heraklion, Crete, Greece

    Panos E. Vardas (Professor of Cardiology) (Professor of Cardiology)

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© 1998 Springer Science+Business Media Dordrecht

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Wiemers, C.K., Ayers, G.M. (1998). Design Concepts for Implantable Atrial Defibrillators. In: Vardas, P.E. (eds) Cardiac Arrhythmias, Pacing & Electrophysiology. Developments in Cardiovascular Medicine, vol 201. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5254-9_38

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  • DOI: https://doi.org/10.1007/978-94-011-5254-9_38

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6210-7

  • Online ISBN: 978-94-011-5254-9

  • eBook Packages: Springer Book Archive

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