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(Circulation. 2000;102:2659.)
© 2000 American Heart Association, Inc.

Basic Science Reports

Reduction of Atrial Defibrillation Threshold With an Interatrial Septal Electrode

Xiangsheng Zheng, MD; Michael E. Benser, PhD; Gregory P. Walcott, MD; Steven D. Girouard, PhD; Dennis L. Rollins, MS; William M. Smith, PhD; Raymond E. Ideker, MD, PhD

From the Division of Cardiovascular Diseases, Department of Medicine, Department of Physiology, and Department of Biomedical Engineering, University of Alabama at Birmingham.

Correspondence to Raymond E. Ideker, MD, PhD, Volker Hall B140, 1670 University Blvd, Birmingham, AL 35294-0019. E-mail rei{at}crml.uab.edu

Background—The standard lead configuration for internal atrial defibrillation consists of a shock between electrodes in the right atrial appendage (RAA) and coronary sinus (CS). We tested the hypothesis that the atrial defibrillation threshold (ADFT) of this RAACS configuration would be lowered with use of an additional electrode at the atrial septum (SP).

Methods and Results—Sustained atrial fibrillation was induced in 8 closed-chest sheep with burst pacing and continuous pericardial infusion of acetyl-ß-methylcholine. Defibrillation electrodes were situated in the RAA, CS, pulmonary artery (PA), low right atrium (LRA), and across the SP. ADFTs of RAACS and 4 other lead configurations were determined in random order by use of a multiple-reversal protocol. Biphasic waveforms of 3/1-ms duration were used for all single and sequential shocks. The ADFT delivered energies for the single-shock configurations were 1.27±0.67 J for RAACS and 0.86±0.59 J for RAA+CSSP; the ADFTs for the sequential-shock configurations were 0.39±0.18 J for RAASP/CSSP, 1.16±0.72 J for CSSP/RAASP, and 0.68±0.46 J for RAACS/LRAPA. Except for CSSP/RAASP versus RAACS and RAACS/LRAPA versus RAA+CSSP, the ADFT delivered energies of all of the configurations were significantly different from each other (P<0.05).

Conclusions—The ADFT of the standard RAACS configuration is markedly reduced with an additional electrode at the atrial SP.

Key Words: defibrillation • atrium • electrophysiology

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