SUCCESSFUL ATRIAL DEFIBRILLATION WITH VERY-LOW-ENERGY SHOCKS BY MEANSOF TEMPORARY EPICARDIAL WIRE ELECTRODES

Sustained atrial fibrillation is very common after cardiac surgical pr ocedures, We hypothesized that atrial defibrillation could be accompli shed consistently and safely by means of low-energy shocks delivered b y temporary stainless steel wire electrodes placed at the time of the operation, Sterile pericarditis was created in five mongrel dogs (20.9 +/- 2.1 kg), and pairs of standard temporary stainless steel sire ele ctrodes were placed on the right atrial appendage, on Bachmann's bundl e, and on the right ventricular apex for pacing, sensing, and recordin g, Temporary stainless steel wire electrodes, insulated except for the distal 6 cm and used to deliver defibrillation shocks, were placed ad jacent to both atrial free walls and secured to the pericardium, All e lectrodes were brought out through the skin, and the sternotomy was cl osed, Dogs were tested in the conscious state on postoperative day 2, Sustained atrial fibrillation was induced by rapid atrial pacing, A cu stomized software program was used to control the defibrillator, which delivered R wave-synchronous biphasic shocks to the atria through the temporary defibrillation electrodes, The shock intensity began at 50 volts and was increased by 10-volt increments until atrial fibrillatio n was terminated. Atrial fibrillation was terminated in all dogs at 11 2 +/- 7 volts, with an energy of 0.42 +/- 0.07 joule and an impedance of 67.8 +/- 4 ohms (all values mean +/- standard error of the mean), T he mean percent success for atrial defibrillation at this minimal thre shold was 49%, Thus at low-threshold voltages atrial fibrillation coul d be terminated with every other shock. A 25% increase in the minimal threshold voltage improved the conversion rate to 73% (mean energy 0.6 6 a 0.19 joule and mean impedance of 67 +/- 3.8 ohms), No complication s were detected with the use of the electrodes or after their removal on the seventh postoperative day, One instance of electrode migration on the right atrial free wall was detected by roentgenography, but thi s did not adversely affect atrial defibrillation threshold. No ventric ular arrhythmias or hemodynamic complications were noted during shock delivery, We conclude that successful conversion of atrial fibrillatio n to sinus rhythm can be achieved consistently with shock energies bel ow 0.5 joule delivered with temporary epicardial defibrillation wire e lectrodes in this canine pericarditis model, These results suggest tha t this approach to the management of sustained atrial tachyarrhythmias has considerable promise in the management of atrial fibrillation in patients who have had cardiac operations.