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Induction of atrial fibrillation with rapid high voltage ventricular pacing for ventricular fibrillation conversion
A Schuchert1, M Kühl, R Rüppel
1Medical Clinic, Department of Cardiology, University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Insights
Rapid ventricular pacing frequently induces atrial fibrillation during implantable cardioverter-defibrillator (ICD) testing. This induced atrial fibrillation is not linked to a patient's specific heart condition.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing ventricular arrhythmias.
- Understanding potential side effects of ICD testing, such as induced atrial fibrillation, is important for patient management.
Purpose of the Study:
- To determine if rapid high-voltage ventricular pacing can induce atrial fibrillation.
- To investigate the relationship between induced atrial fibrillation and a patient's underlying heart disease during ventricular fibrillation conversion testing.
Main Methods:
- A prospective study involving 50 patients receiving a dual-chamber ICD (Ventak AV II DR).
- The ICD device was capable of recording atrial activity during ventricular fibrillation and inducing atrial fibrillation via rapid atrial bursts.
- Analysis of atrial fibrillation frequency post-ventricular fibrillation induction and correlation with patient clinical characteristics.
Main Results:
- Atrial fibrillation was induced in 18% of ventricular fibrillation episodes following high-voltage pacing.
- The ICD's biphasic shock successfully terminated both ventricular fibrillation and induced atrial fibrillation in all instances.
- Induced atrial fibrillation occurred in 36% of patients, with no significant differences in clinical characteristics or inducibility based on underlying heart disease.
Conclusions:
- Rapid high-voltage ventricular pacing is a frequent trigger for atrial fibrillation during ICD testing.
- The induction of atrial fibrillation appears to be a non-specific event, not directly related to the patient's clinical condition.
- Subsequent ICD shocks effectively terminate both ventricular and atrial fibrillation.
Objective:
To assess whether rapid high voltage ventricular pacing can also induce atrial fibrillation, and whether the induction of atrial fibrillation during ventricular fibrillation conversion testing is related to the patient's heart disease.
Design:
Prospective study of 50 patients who received the dual chamber implantable cardioverter-defibrillator (ICD) Ventak AV II DR (Guidant) as a first implant. This device can record atrial activity even during a ventricular fibrillation episode and can induce atrial fibrillation by rapid atrial bursts.
Main Outcome Measures:
Frequency of atrial fibrillation after induction of ventricular fibrillation; clinical characteristics of patients with and without induced atrial fibrillation; frequency of atrial fibrillation induced by rapid atrial bursts during predischarge testing.
Results:
Atrial fibrillation was observed in 40 of the 217 ventricular fibrillation episodes (18%) that could be detected immediately after delivery of high voltage pacing. The biphasic ICD shock for termination of ventricular fibrillation also terminated the atrial fibrillation in all cases. The 40 episodes of simultaneous atrial and ventricular fibrillation occurred in 18 patients (36%). The distribution of the clinical characteristics of the patients and the inducibility of atrial fibrillation during predischarge testing were similar in those with and without induced atrial fibrillation.
Conclusions:
Rapid high voltage ventricular pacing frequently induces atrial fibrillation, which was terminated by the subsequent biphasic ICD shock. The induction of atrial fibrillation seems to be a non-specific phenomenon, unrelated to the clinical status of the patient.