Multicenter Low Energy Transvenous Atrial Defibrillation (XAD) Trial Results in Different Subsets of Atrial Fibrillation

Lévy, Samuel; Ricard, Philippe; Lau, Chu‐Pak; Lok, Ngai‐Sang; Camm, A. John; Murgatroyd, Francis; Jordaens, Luc; Kappenberger, Lukas; Brugada, Pedro; Ripley, K.L.

doi:10.1016/s0735-1097(96)00583-9

Cited by 158 publications

(75 citation statements)

References 18 publications

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“…1 Defibrillation with transvenous catheter-based electrodes has been shown to be safe and effective for restoration of sinus rhythm, even in patients who have failed attempts to restore sinus rhythm with transthoracic shocks. [2][3][4] From this experience, an implanted atrial defibrillator was developed to treat patients with recurrent, symptomatic, drug-refractory atrial fibrillation. Previous studies have reported accurate device detection and safe cardioversion of symptomatic atrial fibrillation; however, device activation and therapy delivery were performed in the hospital under the direction of a physician.…”

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confidence: 99%

Initial Clinical Experience With Ambulatory Use of an Implantable Atrial Defibrillator for Conversion of Atrial Fibrillation

et al. 2000

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Background —A recent study has shown that the implantable atrial defibrillator can restore sinus rhythm in patients with recurrent atrial fibrillation when therapy was delivered under physician observation. The objective of this study was to evaluate the safety and efficacy of ambulatory use of the implantable atrial defibrillator. Methods and Results —An atrial defibrillator was implanted in 105 patients (75 men; mean age, 59±12 years) with recurrent, symptomatic, drug-refractory atrial fibrillation. After successful 3-month testing, patients could transition to ambulatory delivery of shock therapy. Patients completed questionnaires regarding shock therapy discomfort and therapy satisfaction using a 10-point visual-analog scale (1 represented “not at all,” 10 represented “extremely”) after each treated episode of atrial fibrillation. During a mean follow-up of 11.7 months, 48 of 105 patients satisfied criteria for transition and received therapy for 275 episodes of atrial fibrillation. Overall shock therapy efficacy was 90% with 1.6±1.2 shocks delivered per episode (median, 1). Patients rated shock discomfort as 5.2±2.4 for successful therapy and 4.2±2.2 for unsuccessful therapy ( P >0.05). The satisfaction score was higher for successful versus unsuccessful therapy (3.4±3.3 versus 8.7±1.3, P <0.05). There was no ventricular proarrhythmia observed throughout the course of this study. Conclusions —Ambulatory use of an implantable atrial defibrillator can safely and successfully convert most episodes of atrial fibrillation, often requiring only a single shock. Successful therapy is associated with high satisfaction and only moderate discomfort.

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confidence: 99%

Initial Clinical Experience With Ambulatory Use of an Implantable Atrial Defibrillator for Conversion of Atrial Fibrillation

et al. 2000

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“…Although the 10-ms 100-V setting had a better success rate than the 20-ms 75-V setting (97.5Ϯ2.5%; 1.87Ϯ0.02 J), this did not reach statistical significance. The high success rates were also maintained for longer pulse widths (12,15,20, and 30 ms) at the 100-V setting compared with the 10-ms setting, but there was a progressive increase in delivered energy.…”

Section: Success Ratesmentioning

confidence: 84%

“…Phase 1: We randomly assessed the PIAD at 3 voltages of 50, 75, and 100 V. The 50-and 100-V settings were assessed in 10 sheep at pulse widths of 5,6,8,10,12,15,20, and 30 ms. The 75-V setting was assessed in 8 of the 10 sheep and at the 8-, 10-, 12-, 15-and 20-ms pulse widths.…”

Section: Protocolmentioning

confidence: 99%

Novel Passive Implantable Atrial Defibrillator Using Transcutaneous Radiofrequency Energy Transmission Successfully Cardioverts Atrial Fibrillation

Manoharan

Evans²,

Kidwai³

et al. 2003

Circulation

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Background-Conventional methods for cardioversion of atrial fibrillation (AF) to sinus rhythm have numerous difficulties. A novel method for cardioversion using the passive implantable atrial defibrillator (PIAD) was tested in acute animal models. This device does not have a battery or a capacitor to store energy and is activated by transferring RF energy across the skin from an external transmitter to the subcutaneously implanted defibrillator. On activation, a novel monophasic shock waveform with 5% tilt is delivered to the heart via 2 intracardiac defibrillation leads. Methods and Results-Cardioversion attempts with the device were assessed in 2 phases: a feasibility and efficacy study and randomized comparison against standard waveforms. Defibrillation leads were placed transvenously into the distal coronary sinus and the right atrial appendage. These were connected to the subcutaneously implanted PIAD. Sustained AF was induced by rapid atrial pacing. The transmitter coil was placed on the skin overlying the defibrillator, and defibrillation synchronized to the R wave was attempted. The method was found to be efficacious at very low voltage and energy, with 100% cardioversion success observed for 10-ms 100-V shocks (mean energy, 1.54Ϯ0.02 J). The PIAD waveform had a higher cardioversion success rate than a truncated, 70% tilt monophasic exponential pulse (100 V, 100% versus 78.0Ϯ7.57%; Pϭ0.001). There were no postshock complications. Conclusions-Considering these animal results, this method is promising for cardioverting AF in symptomatic patients.

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“…The use of an implantable atrial defibrillator system to deliver low-energy shocks between special catheter electrodes permanently placed in the right atrium and coronary sinus has been under systematic study for many years, first in experimental models and more recently in patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] It is clear that the device can be used successfully to defibrillate the atria in most patients with paroxysmal or persistent atrial fibrillation. It is also clear that if the shock is synchronized to ventricular activation so that it is not delivered during the T wave of the preceding QRS complex, something that the device has been reliably programmed to do, the shock can be delivered safely.…”

Section: See P 883mentioning

confidence: 99%

“…[1][2][3][4] We have also known that synchronized delivery of a low-energy DC shock for cardioversion of atrial fibrillation is very effective. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] With the presentation by Liebold et al 22 of the study of 100 consecutive patients undergoing open heart surgery, we now have the demonstration of a new clinical application of both the use of temporary epicardial atrial wire electrodes and low-energy DC cardioversion of atrial fibrillation. The article by Liebold et al 22 is actually about 2 things.…”

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confidence: 99%

Low-Energy Atrial Defibrillation

Waldo

1998

Circulation

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T emporary epicardial wire electrodes placed during open heart surgery for potential diagnostic and/or therapeutic use in patients in the immediate postoperative period have been used safely and effectively as part of standard care for a long time. [1][2][3][4] We have also known that synchronized delivery of a low-energy DC shock for cardioversion of atrial fibrillation is very effective. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] With the presentation by Liebold et al 22 of the study of 100 consecutive patients undergoing open heart surgery, we now have the demonstration of a new clinical application of both the use of temporary epicardial atrial wire electrodes and low-energy DC cardioversion of atrial fibrillation. The article by Liebold et al 22 is actually about 2 things. One is a new therapeutic modality in the treatment of atrial fibrillation in the period immediately after open heart surgery. The other is the efficacy, safety, and tolerance of so-called low-energy atrial defibrillation. See p 883It is widely recognized that atrial fibrillation is a common and important problem in patients who have had open heart surgery. As recently summarized, 23 many studies have examined its potential cause(s), prevention, and treatment. Unfortunately, although these studies have provided some insights, the problem has abated little. Thus, according to the study by Liebold et al, 22 the demonstration of a new, effective treatment, low-energy atrial defibrillation with temporary epicardial wire electrodes placed on each atrium, is most welcome. The technique, initially studied in an animal model, 12,16 also permits standard use of epicardial wire electrodes for recording (diagnostic) and pacing (therapeutic and diagnostic) purposes, just as the traditional temporary epicardial atrial wire electrodes have been used in the past.1-4 Nevertheless, use of this technique does not change the problem, which is frequency of postoperative atrial fibrillation. Rather, it offers a much easier way to provide DC cardioversion of atrial fibrillation, when indicated, than the traditional delivery of a transthoracic DC shock. Early or late recurrence of atrial fibrillation notwithstanding, the technique of low-energy atrial defibrillation with temporary epicardial atrial wire electrodes should find a place in the standard treatment regimen for atrial fibrillation after open heart surgery.Perhaps the more important implications of the study by Liebold et al 22 pertain to the use of low-energy DC cardioversion of atrial fibrillation with the implantable atrial defibrillator. The use of an implantable atrial defibrillator system to deliver low-energy shocks between special catheter electrodes permanently placed in the right atrium and coronary sinus has been under systematic study for many years, first in experimental models and more recently in patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] It is clear that the device can be used successfully to defibrillate the atria in most patients with...

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Multicenter Low Energy Transvenous Atrial Defibrillation (XAD) Trial Results in Different Subsets of Atrial Fibrillation

Cited by 158 publications

References 18 publications

Initial Clinical Experience With Ambulatory Use of an Implantable Atrial Defibrillator for Conversion of Atrial Fibrillation

Initial Clinical Experience With Ambulatory Use of an Implantable Atrial Defibrillator for Conversion of Atrial Fibrillation

Novel Passive Implantable Atrial Defibrillator Using Transcutaneous Radiofrequency Energy Transmission Successfully Cardioverts Atrial Fibrillation

Low-Energy Atrial Defibrillation

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