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Is the automatic atrial defibrillator a promising approach?
J C Griffin1, G M Ayers, J Adams
1InControl Inc., Redmond, WA 98052, USA.
Insights
Atrial fibrillation, a common heart rhythm disorder, can be treated with low-energy electrical shocks. Implantable devices show promise for managing recurring episodes of this condition.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation is a prevalent arrhythmia with significant healthcare resource utilization.
- It causes loss of atrial contraction and impairs cardiac rate control.
- Previous animal studies showed feasibility of intravenous atrial defibrillation.
Purpose of the Study:
- To evaluate the effectiveness and safety of low-energy atrial defibrillation.
- To explore the potential of implantable devices for managing drug-refractory atrial fibrillation.
Main Methods:
- Intravenous electrode placement for atrial defibrillation.
- Delivery of low-energy electrical shocks synchronized to the R wave.
- Assessment of shock efficacy in converting atrial fibrillation.
- Evaluation of safety, particularly concerning preceding RR intervals.
Main Results:
- Low-energy shocks were effective in converting atrial fibrillation.
- Shocks were safe when delivered synchronously to the R wave and without short preceding RR intervals.
- Preliminary data suggests potential benefit from small implanted devices for recurrent, refractory cases.
Conclusions:
- Low-energy atrial defibrillation is effective and safe under specific conditions.
- Implantable devices represent a promising therapeutic option for patients with persistent, drug-refractory atrial fibrillation.
Abstract:
Atrial fibrillation is a common arrhythmia, accounting for more consumption of medical resources than any other arrhythmia. The impact of the disease results from the combination of a loss of atrial contraction, and atrial control over cardiac rate. Studies in animals demonstrated the basic feasibility of atrial defibrillation using electrodes passed intravenously. Subsequent studies in patients confirmed that low-energy shocks were effective in converting atrial fibrillation and were safe if delivered synchronous to the R wave in the absence of a short preceding RR interval. Preliminary experience suggests that a small implanted device might provide beneficial therapy for patients with recurring episodes of persistent, drug-refractory, atrial fibrillation.