Low-Energy Multistage Atrial Defibrillation Therapy Terminates Atrial Fibrillation With Less Energy Than a Single Shock
BACKGROUND—Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multistage defibrillation therapy and tested it in a canine model of AF. METHODS AND RESULTS—AF was induced by burst pacing during vagus nerve stimulation. Our nove...
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| Veröffentlicht in: | Circulation. Arrhythmia and electrophysiology 2011-12, Vol.4 (6), p.917-925 |
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| container_title | Circulation. Arrhythmia and electrophysiology |
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| creator | Li, Wenwen Janardhan, Ajit H Fedorov, Vadim V Sha, Qun Schuessler, Richard B Efimov, Igor R |
| description | BACKGROUND—Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multistage defibrillation therapy and tested it in a canine model of AF.
METHODS AND RESULTS—AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of 3 stagesstage (ST) 1 (1–4 low-energy biphasic [BP] shocks), ST2 (6–10 ultralow-energy monophasic [MP] shocks), and ST3 (antitachycardia pacing). First, ST1 testing compared single or multiple MP and BP shocks. Second, several multistage therapies were testedST1 versus ST1+ST3 versus ST1+ST2+ST3. Third, 3 shock vectors were comparedsuperior vena cava to distal coronary sinus, proximal coronary sinus to left atrial appendage, and right atrial appendage to left atrial appendage. The atrial defibrillation threshold (DFT) of 1 BP shock was |
| doi_str_mv | 10.1161/CIRCEP.111.965830 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_913033175</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>913033175</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4180-c3612fb884995fec38ab786e1a5e50126e7be0580e2e846e304218df99dac0503</originalsourceid><addsrcrecordid>eNpNkE9v00AQxVcIREvhA3BBe0GcXGa8f7x7rEIKlYJANIijtXbG8dKNne7aivLtceUEOIzmHX7vzegx9hbhGlHjx8Xdj8Xy-6Tx2mplBDxjl2glZgKMfH7WKO0Fe5XSbwCNBvVLdpGjNQCFvmSHVX_Ilh3F7ZF_HcPg0-C2xG-G6F3gn6jxVfQhuMH3HV-3FN3-yNcUd75zA6UzePs_9ssPLV9RSvwUvG5dxx2_9902EL9v-_rhNXvRuJDozWlfsZ-3y_XiS7b69vlucbPKaokGslpozJvKGGmtaqgWxlWF0YROkQLMNRUVgTJAORmpSYDM0WwaazeuBgXiin2Yc_exfxwpDeXOp5qmVzvqx1RaFCAEFmoicSbr2KcUqSn30e9cPJYI5VPd5Vz3pLGc6548707pY7WjzV_Hud8JeH8CXKpdaKLrap_-cUoUhVRPnJy5Qx8GiukhjAeKZUsuDG0JKEQhrchymI7nAJBNk4P4A9g1mAA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>913033175</pqid></control><display><type>article</type><title>Low-Energy Multistage Atrial Defibrillation Therapy Terminates Atrial Fibrillation With Less Energy Than a Single Shock</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Li, Wenwen ; Janardhan, Ajit H ; Fedorov, Vadim V ; Sha, Qun ; Schuessler, Richard B ; Efimov, Igor R</creator><creatorcontrib>Li, Wenwen ; Janardhan, Ajit H ; Fedorov, Vadim V ; Sha, Qun ; Schuessler, Richard B ; Efimov, Igor R</creatorcontrib><description>BACKGROUND—Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multistage defibrillation therapy and tested it in a canine model of AF.
METHODS AND RESULTS—AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of 3 stagesstage (ST) 1 (1–4 low-energy biphasic [BP] shocks), ST2 (6–10 ultralow-energy monophasic [MP] shocks), and ST3 (antitachycardia pacing). First, ST1 testing compared single or multiple MP and BP shocks. Second, several multistage therapies were testedST1 versus ST1+ST3 versus ST1+ST2+ST3. Third, 3 shock vectors were comparedsuperior vena cava to distal coronary sinus, proximal coronary sinus to left atrial appendage, and right atrial appendage to left atrial appendage. The atrial defibrillation threshold (DFT) of 1 BP shock was <1 MP shock (0.55±0.1 versus 1.38±0.31 J, P=0.003). Two to 3 BP shocks terminated AF with lower peak voltage than 1 BP or 1 MP shock and with lower atrial DFT than 4 BP shocks. Compared with ST1 therapy alone, ST1+ST3 lowered the atrial DFT moderately (0.51±0.46 versus 0.95±0.32 J, P=0.036), whereas 3-stage therapy (ST1+ST2+ST3) dramatically lowered the atrial DFT (0.19±0.12 versus 0.95±0.32 J for ST1 alone, P=0.0012). Finally, the 3-stage therapy was equally effective for all studied vectors.
CONCLUSIONS—Three-stage electrotherapy significantly reduces the AF DFT and opens the door to low-energy atrial defibrillation at or below the pain threshold.</description><identifier>ISSN: 1941-3149</identifier><identifier>EISSN: 1941-3084</identifier><identifier>DOI: 10.1161/CIRCEP.111.965830</identifier><identifier>PMID: 21980076</identifier><language>eng</language><publisher>Hagerstown, MD: American Heart Association, Inc</publisher><subject>Animals ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - etiology ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - therapy ; Atrial Function ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiac Pacing, Artificial ; Cardiology. Vascular system ; Defibrillators, Implantable ; Disease Models, Animal ; Dogs ; Electric Countershock - adverse effects ; Electric Countershock - instrumentation ; Electric Countershock - methods ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Equipment Design ; Heart ; Heart Atria - physiopathology ; Heart Conduction System - physiopathology ; Medical sciences ; Pain - etiology ; Pain - prevention & control ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Time Factors ; Vagus Nerve Stimulation</subject><ispartof>Circulation. Arrhythmia and electrophysiology, 2011-12, Vol.4 (6), p.917-925</ispartof><rights>2011 American Heart Association, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4180-c3612fb884995fec38ab786e1a5e50126e7be0580e2e846e304218df99dac0503</citedby><cites>FETCH-LOGICAL-c4180-c3612fb884995fec38ab786e1a5e50126e7be0580e2e846e304218df99dac0503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,3674,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25377456$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21980076$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Wenwen</creatorcontrib><creatorcontrib>Janardhan, Ajit H</creatorcontrib><creatorcontrib>Fedorov, Vadim V</creatorcontrib><creatorcontrib>Sha, Qun</creatorcontrib><creatorcontrib>Schuessler, Richard B</creatorcontrib><creatorcontrib>Efimov, Igor R</creatorcontrib><title>Low-Energy Multistage Atrial Defibrillation Therapy Terminates Atrial Fibrillation With Less Energy Than a Single Shock</title><title>Circulation. Arrhythmia and electrophysiology</title><addtitle>Circ Arrhythm Electrophysiol</addtitle><description>BACKGROUND—Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multistage defibrillation therapy and tested it in a canine model of AF.
METHODS AND RESULTS—AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of 3 stagesstage (ST) 1 (1–4 low-energy biphasic [BP] shocks), ST2 (6–10 ultralow-energy monophasic [MP] shocks), and ST3 (antitachycardia pacing). First, ST1 testing compared single or multiple MP and BP shocks. Second, several multistage therapies were testedST1 versus ST1+ST3 versus ST1+ST2+ST3. Third, 3 shock vectors were comparedsuperior vena cava to distal coronary sinus, proximal coronary sinus to left atrial appendage, and right atrial appendage to left atrial appendage. The atrial defibrillation threshold (DFT) of 1 BP shock was <1 MP shock (0.55±0.1 versus 1.38±0.31 J, P=0.003). Two to 3 BP shocks terminated AF with lower peak voltage than 1 BP or 1 MP shock and with lower atrial DFT than 4 BP shocks. Compared with ST1 therapy alone, ST1+ST3 lowered the atrial DFT moderately (0.51±0.46 versus 0.95±0.32 J, P=0.036), whereas 3-stage therapy (ST1+ST2+ST3) dramatically lowered the atrial DFT (0.19±0.12 versus 0.95±0.32 J for ST1 alone, P=0.0012). Finally, the 3-stage therapy was equally effective for all studied vectors.
CONCLUSIONS—Three-stage electrotherapy significantly reduces the AF DFT and opens the door to low-energy atrial defibrillation at or below the pain threshold.</description><subject>Animals</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - etiology</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - therapy</subject><subject>Atrial Function</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiac Pacing, Artificial</subject><subject>Cardiology. Vascular system</subject><subject>Defibrillators, Implantable</subject><subject>Disease Models, Animal</subject><subject>Dogs</subject><subject>Electric Countershock - adverse effects</subject><subject>Electric Countershock - instrumentation</subject><subject>Electric Countershock - methods</subject><subject>Electrocardiography</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Equipment Design</subject><subject>Heart</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Conduction System - physiopathology</subject><subject>Medical sciences</subject><subject>Pain - etiology</subject><subject>Pain - prevention & control</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Time Factors</subject><subject>Vagus Nerve Stimulation</subject><issn>1941-3149</issn><issn>1941-3084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkE9v00AQxVcIREvhA3BBe0GcXGa8f7x7rEIKlYJANIijtXbG8dKNne7aivLtceUEOIzmHX7vzegx9hbhGlHjx8Xdj8Xy-6Tx2mplBDxjl2glZgKMfH7WKO0Fe5XSbwCNBvVLdpGjNQCFvmSHVX_Ilh3F7ZF_HcPg0-C2xG-G6F3gn6jxVfQhuMH3HV-3FN3-yNcUd75zA6UzePs_9ssPLV9RSvwUvG5dxx2_9902EL9v-_rhNXvRuJDozWlfsZ-3y_XiS7b69vlucbPKaokGslpozJvKGGmtaqgWxlWF0YROkQLMNRUVgTJAORmpSYDM0WwaazeuBgXiin2Yc_exfxwpDeXOp5qmVzvqx1RaFCAEFmoicSbr2KcUqSn30e9cPJYI5VPd5Vz3pLGc6548707pY7WjzV_Hud8JeH8CXKpdaKLrap_-cUoUhVRPnJy5Qx8GiukhjAeKZUsuDG0JKEQhrchymI7nAJBNk4P4A9g1mAA</recordid><startdate>201112</startdate><enddate>201112</enddate><creator>Li, Wenwen</creator><creator>Janardhan, Ajit H</creator><creator>Fedorov, Vadim V</creator><creator>Sha, Qun</creator><creator>Schuessler, Richard B</creator><creator>Efimov, Igor R</creator><general>American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201112</creationdate><title>Low-Energy Multistage Atrial Defibrillation Therapy Terminates Atrial Fibrillation With Less Energy Than a Single Shock</title><author>Li, Wenwen ; Janardhan, Ajit H ; Fedorov, Vadim V ; Sha, Qun ; Schuessler, Richard B ; Efimov, Igor R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4180-c3612fb884995fec38ab786e1a5e50126e7be0580e2e846e304218df99dac0503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Animals</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - etiology</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - therapy</topic><topic>Atrial Function</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiac Pacing, Artificial</topic><topic>Cardiology. Vascular system</topic><topic>Defibrillators, Implantable</topic><topic>Disease Models, Animal</topic><topic>Dogs</topic><topic>Electric Countershock - adverse effects</topic><topic>Electric Countershock - instrumentation</topic><topic>Electric Countershock - methods</topic><topic>Electrocardiography</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Equipment Design</topic><topic>Heart</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Conduction System - physiopathology</topic><topic>Medical sciences</topic><topic>Pain - etiology</topic><topic>Pain - prevention & control</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Time Factors</topic><topic>Vagus Nerve Stimulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Wenwen</creatorcontrib><creatorcontrib>Janardhan, Ajit H</creatorcontrib><creatorcontrib>Fedorov, Vadim V</creatorcontrib><creatorcontrib>Sha, Qun</creatorcontrib><creatorcontrib>Schuessler, Richard B</creatorcontrib><creatorcontrib>Efimov, Igor R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Arrhythmia and electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Wenwen</au><au>Janardhan, Ajit H</au><au>Fedorov, Vadim V</au><au>Sha, Qun</au><au>Schuessler, Richard B</au><au>Efimov, Igor R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low-Energy Multistage Atrial Defibrillation Therapy Terminates Atrial Fibrillation With Less Energy Than a Single Shock</atitle><jtitle>Circulation. Arrhythmia and electrophysiology</jtitle><addtitle>Circ Arrhythm Electrophysiol</addtitle><date>2011-12</date><risdate>2011</risdate><volume>4</volume><issue>6</issue><spage>917</spage><epage>925</epage><pages>917-925</pages><issn>1941-3149</issn><eissn>1941-3084</eissn><abstract>BACKGROUND—Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multistage defibrillation therapy and tested it in a canine model of AF.
METHODS AND RESULTS—AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of 3 stagesstage (ST) 1 (1–4 low-energy biphasic [BP] shocks), ST2 (6–10 ultralow-energy monophasic [MP] shocks), and ST3 (antitachycardia pacing). First, ST1 testing compared single or multiple MP and BP shocks. Second, several multistage therapies were testedST1 versus ST1+ST3 versus ST1+ST2+ST3. Third, 3 shock vectors were comparedsuperior vena cava to distal coronary sinus, proximal coronary sinus to left atrial appendage, and right atrial appendage to left atrial appendage. The atrial defibrillation threshold (DFT) of 1 BP shock was <1 MP shock (0.55±0.1 versus 1.38±0.31 J, P=0.003). Two to 3 BP shocks terminated AF with lower peak voltage than 1 BP or 1 MP shock and with lower atrial DFT than 4 BP shocks. Compared with ST1 therapy alone, ST1+ST3 lowered the atrial DFT moderately (0.51±0.46 versus 0.95±0.32 J, P=0.036), whereas 3-stage therapy (ST1+ST2+ST3) dramatically lowered the atrial DFT (0.19±0.12 versus 0.95±0.32 J for ST1 alone, P=0.0012). Finally, the 3-stage therapy was equally effective for all studied vectors.
CONCLUSIONS—Three-stage electrotherapy significantly reduces the AF DFT and opens the door to low-energy atrial defibrillation at or below the pain threshold.</abstract><cop>Hagerstown, MD</cop><pub>American Heart Association, Inc</pub><pmid>21980076</pmid><doi>10.1161/CIRCEP.111.965830</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Animals Atrial Fibrillation - diagnosis Atrial Fibrillation - etiology Atrial Fibrillation - physiopathology Atrial Fibrillation - therapy Atrial Function Biological and medical sciences Cardiac dysrhythmias Cardiac Pacing, Artificial Cardiology. Vascular system Defibrillators, Implantable Disease Models, Animal Dogs Electric Countershock - adverse effects Electric Countershock - instrumentation Electric Countershock - methods Electrocardiography Electrophysiologic Techniques, Cardiac Equipment Design Heart Heart Atria - physiopathology Heart Conduction System - physiopathology Medical sciences Pain - etiology Pain - prevention & control Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Time Factors Vagus Nerve Stimulation |
| title | Low-Energy Multistage Atrial Defibrillation Therapy Terminates Atrial Fibrillation With Less Energy Than a Single Shock |
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