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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)
 
 
 
 
 

Effect of coronary sinus electrode on the optimal atrial defibrillation pathway for an atrioventricular defibrillator.

INTRODUCTION: Previous studies have demonstrated significant failure in converting atrial fibrillation (AF) using a conventional ventricular pathway. The aim of this study was to assess the benefit of incorporating a coronary sinus (CS) lead into the atrial defibrillation pathway in atrial defibrillation threshold (ADFT) reduction in patients with persistent AF. METHODS AND RESULTS: This study was a prospective, randomized assessment of shock configuration on ADFT in 18 patients undergoing elective internal cardioversion for persistent AF (mean AF duration: 8 +/- 9 months). The lead system included a dual-coil defibrillation lead (Endotak DSP, Guidant) with a distal right ventricular (RV) electrode and a proximal superior vena cava (SVC) electrode, a CS lead (Perimeter, Guidant), and a left pectoral cutaneous electrode (Can). In each patient, dual step-up ADFTs were determined for each of three vectors: (1) RV --> SVC+Can; (2) CS --> SVC+Can; and (3) RV --> CS+SVC+Can (group 1, n = 8) or RV+CS --> SVC+Can (group 2, n = 10), using R wave-synchronized biphasic shocks. Successful defibrillation was achieved in all patients without any ventricular proarrhythmia. ADFT of CS --> SVC+Can (11.8 +/- 5.6 J) was significantly lower than ADFT of RV --> SVC+Can (16.5 +/- 7.8 J, P = 0.021). ADFT of CS --> SVC+Can was similar to RV --> CS+SVC+Can (group 1: 12.0 +/- 6.5 J vs 17.4 +/- 4.8 J, P = 0.16), but it was significantly higher than RV+CS --> SVC+Can (group 2: 9.0 +/- 3.9 J vs 11.6 +/- 5.0 J, P = 0.049). CONCLUSION: Patients with persistent AF of substantial duration can be reliably cardioverted using a conventional implantable cardioverter defibrillator (ICD) lead set; however, the incorporation of a CS lead to the conventional ICD lead configuration significantly lowered ADFT. The optimal shock vector that incorporates a CS lead for atrial defibrillation requires future studies.[1]

References

  1. Effect of coronary sinus electrode on the optimal atrial defibrillation pathway for an atrioventricular defibrillator. Tse, H.F., Timmermans, C., Rodriguez, L.M., Lau, C.P., Wellens, H.J. J. Cardiovasc. Electrophysiol. (2003) [Pubmed]
 
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