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Initial clinical experience with an implantable human atrial defibrillator
1Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Pacing and Clinical Electrophysiology : PACE
|January 1, 1997
Summary
An implantable atrial defibrillator effectively restores sinus rhythm in atrial fibrillation (AF) patients. This device accurately detects AF, synchronizes shocks to R waves, and provides ventricular support, proving a viable therapy.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Low-energy biatrial shocks can restore normal heart rhythm.
- Preventing ventricular proarrhythmia requires precise shock synchronization.
Purpose of the Study:
- To evaluate the efficacy and safety of a novel implantable atrial defibrillator (IAD) for drug-refractory paroxysmal AF.
- To assess the device's ability to detect AF, synchronize shocks, and manage ventricular activity.
Main Methods:
- An IAD was implanted in three patients with paroxysmal AF.
- The device used specific leads for AF detection and defibrillation.
- Shocks were biphasic, up to 300 V, synchronized to R waves.
Main Results:
- The mean implant threshold (ED50) was 195 V (1.8 J).
- Successful defibrillation occurred in 89% of spontaneous AF episodes (260-300 V).
- AF detection was 100% specific, and shocks were 100% synchronized; no ventricular proarrhythmia was observed.
Conclusions:
- The implantable atrial defibrillator is a viable therapeutic option for select patients with paroxysmal AF.
- The device demonstrated accurate AF detection, R-wave synchronization, and effective ventricular support.
- Further research may refine lead placement and shock parameters for optimal outcomes.