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Related Experiment Videos

Rapid atrial pacing does not decrease the atrial defibrillation threshold.

Viveka Frykman1, Borje Darpo, Gregory M Ayers

  • 1Department of Cardiology, Karolinska Hospital, Stockholm Sweden. viveka.frykman@telia.com

Pacing and Clinical Electrophysiology : PACE
|August 14, 2003
PubMed
Summary

Preshock atrial pacing did not significantly lower the atrial defibrillation threshold (ADFT) for internal cardioversion of atrial fibrillation (AF). This study found no benefit in using rapid atrial pacing before a defibrillation shock to reduce energy requirements in AF patients.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Implantable atrial defibrillators offer therapeutic options for persistent atrial fibrillation (AF).
  • Patient discomfort during cardioversion is a limitation, necessitating methods to lower the atrial defibrillation threshold (ADFT).

Purpose of the Study:

  • To evaluate the effect of preshock atrial pacing on the ADFT during internal cardioversion of AF.
  • To determine if rapid atrial pacing can reduce the energy required for successful cardioversion.

Main Methods:

  • A randomized, crossover study involving 11 patients with AF undergoing internal cardioversion.
  • ADFT testing used a step-up protocol comparing pacing + shock versus shock only.
  • Rapid atrial pacing was delivered at 90% of the average cycle length of fibrillatory waves.

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Main Results:

  • Preshock atrial pacing did not significantly influence the internal ADFT in AF patients (P > 0.05).
  • The mean ADFT with pacing + shock was 260 +/- 84 V (3.4 +/- 2.9 J) compared to 268 +/- 85 V (3.8 +/- 3.0 J) for shock only.
  • The study protocol demonstrated reproducibility and usefulness for testing interventions on ADFT.

Conclusions:

  • Rapid atrial pacing does not appear to lower the internal atrial defibrillation threshold for AF cardioversion.
  • The randomized, crossover protocol is reproducible and suitable for evaluating interventions aimed at reducing ADFT.