This Article Full Text Full Text (PDF) All Versions of this Article: 108/11/1382    most recent 01.CIR.0000087594.42881.3Cv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Manoharan, G. Articles by Adgey, J. Search for Related Content PubMed PubMed Citation Articles by Manoharan, G. Articles by Adgey, J. Related Collections Arrythmias-basic studies Ablation/ICD/surgery

(Circulation. 2003;108:1382.)
© 2003 American Heart Association, Inc.

Basic Science Reports

Novel Passive Implantable Atrial Defibrillator Using Transcutaneous Radiofrequency Energy Transmission Successfully Cardioverts Atrial Fibrillation

Ganesh Manoharan, MD; Noel Evans, PhD; Bakthiar Kidwai, MB; Desmond Allen, MD; John Anderson, DPhil; Jennifer Adgey, MD

From the Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast (G.M., B.K., D.A., J. Adgey); the Department of Engineering, University of Ulster, Jordanstown, Northern Ireland (G.M., N.E., J. Anderson); and the Department of Physiology, Queen’s University of Belfast, Belfast (G.M., B.K., D.A.), UK.

Correspondence to Dr Ganesh Manoharan, Regional Medical Cardiology Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.

Received December 10, 2002; de novo received February 28, 2003; revision received May 16, 2003; accepted May 16, 2003.

Background— Conventional methods for cardioversion of atrial fibrillation (AF) to sinus rhythm have numerous difficulties. A novel method for cardioversion using the passive implantable atrial defibrillator (PIAD) was tested in acute animal models. This device does not have a battery or a capacitor to store energy and is activated by transferring RF energy across the skin from an external transmitter to the subcutaneously implanted defibrillator. On activation, a novel monophasic shock waveform with 5% tilt is delivered to the heart via 2 intracardiac defibrillation leads.

Methods and Results— Cardioversion attempts with the device were assessed in 2 phases: a feasibility and efficacy study and randomized comparison against standard waveforms. Defibrillation leads were placed transvenously into the distal coronary sinus and the right atrial appendage. These were connected to the subcutaneously implanted PIAD. Sustained AF was induced by rapid atrial pacing. The transmitter coil was placed on the skin overlying the defibrillator, and defibrillation synchronized to the R wave was attempted. The method was found to be efficacious at very low voltage and energy, with 100% cardioversion success observed for 10-ms 100-V shocks (mean energy, 1.54±0.02 J). The PIAD waveform had a higher cardioversion success rate than a truncated, 70% tilt monophasic exponential pulse (100 V, 100% versus 78.0±7.57%; P=0.001). There were no postshock complications.

Conclusions— Considering these animal results, this method is promising for cardioverting AF in symptomatic patients.

Key Words: arrhythmia • fibrillation • cardioversion

This article has been cited by other articles:

				S. J. Walsh, G. Manoharan, O. J. Escalona, J. Santos, N. Evans, J. McC. Anderson, M. Stevenson, J. D. Allen, and A.A. J. Adgey Novel rectangular biphasic and monophasic waveforms delivered by a radiofrequency-powered defibrillator compared with conventional capacitor-based waveforms in transvenous cardioversion of atrial fibrillation. Europace, October 1, 2006; 8(10): 873 - 880. [Abstract] [Full Text] [PDF]

				A A J Adgey and S J Walsh Theory and practice of defibrillation: (1) Atrial fibrillation and DC conversion Heart, December 1, 2004; 90(12): 1493 - 1498. [Full Text] [PDF]

				G. Manoharan, N. Evans, D. Allen, J. Anderson, and J. Adgey Comparing the Efficacy and Safety of a Novel Monophasic Waveform Delivered by the Passive Implantable Atrial Defibrillator With Biphasic Waveforms in Cardioversion of Atrial Fibrillation Circulation, April 6, 2004; 109(13): 1686 - 1692. [Abstract] [Full Text] [PDF]