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Initial Experience with a New Balloon‐Guided Single Lead Catheter for Internal Cardioversion of Atrial Fibrillation and Dual Chamber Pacing
Author(s) -
PLEWAN A.,
VALINA C.,
HERRMANN R.,
ALT E.
Publication year - 1999
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1999.tb00338.x
Subject(s) - medicine , defibrillation , cardiology , cardioversion , atrial fibrillation , catheter , pulmonary vein , balloon , coronary sinus , atrium (architecture) , single chamber , sinus rhythm , balloon catheter , anesthesia , surgery
Background: Based on the observation that internal cardioversion (IntCV) of atrial fibrillation is effective with electrodes in the right atrium and pulmonary artery, a new balloon‐guided catheter and external defibrillation device with optional dual chamber pacing was evaluated. Methods: IntCV was attempted in 27 patients (age: 57 ± 10 years, duration: 14 ± 18 months, left atrial diameter 56 ± 8 mm) using a new defibrillation device (Alert, EP MedSystems, Inc., NJ, USA) that allows the delivery of biphasic shocks (0.5–15 J, variable tilt), atrial and ventricular pacing, and online signal recording. Pacing and defibrillation shocks were applied via a 7.5 Fr balloon‐guided catheter (EP MedSystems, Inc.). Pacing, sensing, and triggering were established through the proximal atrial array and an electrode ring between both defibrillation arrays and a single ventricular electrode ring. Catheters were inserted from the antecubital vein. Results: In 25 of 27 patients sinus rhythm was restored with a mean energy of 6.7 ± 4.5 J. In five patients, atrial postshock pacing was required for bradycardia and atrial premature beats. The mean fluoroscopy time was 2.0 ± 1.3 minutes. Conclusion: The high success rate, ease of application, and backup dual chamber pacing suggest that this system is an alternative to established methods of cardioversion. In certain indications, such as failure of prior external cardioversion and situations in which a standard pulmonary balloon catheter is needed, this system would be advantageous.