What is the optimal electrode configuration for atrial defibrillators in man?

Abstract

The right atrium to coronary sinus electrode configuration significantly reduces the atrial DFT. The atrial DFT also remains stable at 3 months post-implantation. Patients with persistent AF undergoing insertion of an atrial defibrillator should have a coronary sinus electrode implanted.

A Biventricular ICD System with Biventricular Defibrillation

“…Placement of shocking electrodes in the coronary sinus has been more commonly seen in atrial defibrillators. Shock vectors incorporating the coronary sinus have been shown to reduce atrial DFTs in patients with AF 9,10 …”

Psychosocial Aspects of Patient‐Activated Atrial Defibrillation

“…Once the audible tones are heard, there is a period of anxiety in preparation for the shock, and it is likely that this increases the shock discomfort. Improved capacitor technology may reduce this delay, and methods to reduce the atrial defibrillation threshold below the pain threshold will improve the tolerability of the shock 6 …”

Reply to the Editor:

“…We thank Mitchell et al for their interest in our article 1 . The electrode configurations tested in their study 2 were different from ours 1 . Mitchell et al showed that atrial defibrillation threshold (ADFT) was lower in the right atrium (RA) coronary sinus (CS) vector than Can right ventricle (RV)+RA.…”