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Dorian P, Cheskes S, Drennan IR. Calibrating Shock Strength for Cardioversion in Atrial Fibrillation: Less Is More or More Is More? Can J Cardiol 2024:S0828-282X(24)00516-6. [PMID: 38960125 DOI: 10.1016/j.cjca.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
| | - Sheldon Cheskes
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Sunnybrook Research Institute and Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto, Ontario, Canada
| | - Ian R Drennan
- Sunnybrook Research Institute and Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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GLOVER BENEDICTM, McCANN CONORJ, MANOHARAN GANESH, WALSH SIMONJ, MOORE MICHAELJ, ALLEN JAMESD, ESCALONA OMAR, ANDERSON JOHNMCC, TROUTON TOMG, STEVENSON MIKE, ROBERTS MICHAELJ, ADGEY JENNIFERAA. A Pilot Study of a Low-Tilt Biphasic Waveform for Transvenous Cardioversion of Atrial Fibrillation: Improved Efficacy Compared with Conventional Capacitor-Based Waveforms in Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1020-4. [DOI: 10.1111/j.1540-8159.2008.01129.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kusumoto FM. Internal Atrial and Ventricular Defibrillation During Electrophysiology Procedures. J Interv Card Electrophysiol 2005; 13 Suppl 1:71-8. [PMID: 16133859 DOI: 10.1007/s10840-005-0753-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 02/28/2005] [Indexed: 10/25/2022]
Abstract
Over the last twenty years internal defibrillation has evolved from an experimental technique into an important adjunctive procedure in the electrophysiology laboratory. Internal deflbrillation is used for treating persistent atrial fibrillation and refractory ventricular arrhythmias. Atrial defibrillation can be performed with several electrode configurations but generally shocks from 1 to 50 joules are delivered between electrodes placed in the coronary sinus and lateral wall of the right atrium. Ventricular defibrillation is usually performed with electrodes in the right ventricle and superior vena cava, although "unipolar" configurations with an internal ventricular electrode and a skin electrode can be used. Currently, internal deflbrillation can be required in 5-10% of cases within the electrophysiology laboratory and will become more commonly used as electrophysiologists perform more complex catheter ablation procedures.
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Affiliation(s)
- Fred M Kusumoto
- Electrophysiology and Pacing Service, Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA.
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Goodman AM, Clyde MA, Burdick DS, Idriss SF, Wolf PD. Minimum energy single-shock internal atrial defibrillation in sheep. J Interv Card Electrophysiol 2004; 10:131-8. [PMID: 15014213 DOI: 10.1023/b:jice.0000019266.09648.f6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Well-tolerated internal atrial defibrillation shocks must be below the pain threshold, which has been estimated to be less than 1 Joule. Defibrillation of the atria with low energy is made possible by delivering shocks at the low end of the defibrillation dose-response curve. We studied low-energy defibrillation in sheep to test the hypothesis that the energy that defibrillates the atria 10% of the time (ED10) is less than 1 Joule. The ED10 was estimated in seven sheep with rapid pacing induced chronic atrial fibrillation (AF). Low-energy defibrillation shocks were delivered from coronary sinus (CS) to superior vena cava (SVC) and the ED10 and ED50 (energy that defibrillates the atria 50% of the time) were then calculated using logistic regression. The mean ratio of ED10 to ED50 was 0.50, indicating that on average, the ED10 was equal to half of the ED50. ED10 shocks had energies ranging from 1.2 to 5.8 Joules. These results suggest that painless single-shock low-energy defibrillation may not be feasible.
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Affiliation(s)
- Amy M Goodman
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
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