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(Circulation. 2001;104:1066.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Right Atrial Septal Electrode for Reducing the Atrial Defibrillation Threshold

Xiangsheng Zheng, MD; Michael E. Benser, PhD; Gregory P. Walcott, MD; Raymond E. Ideker, MD, PhD

From the Division of Cardiovascular Diseases, Department of Medicine (X.Z., G.P.W., R.E.I.), the Department of Physiology (R.E.I.), and the Department of Biomedical Engineering (R.E.I.), University of Alabama, Birmingham; and Guidant Corp (M.E.B.), St Paul, Minn.

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 atrial defibrillation threshold (ADFT) energy of the standard lead configuration, right atrial appendage (RAA) to coronary sinus (CS), was reduced by >50% with the addition of a third electrode traversing the atrial septum in a previous study. This study determined whether the ADFT would be lowered by a more clinically practical third electrode placed in the right atrium along the atrial septum (RSP).

Methods and Results— Sustained atrial fibrillation was induced in 8 closed-chest sheep with burst pacing and maintained with pericardial infusion of acetyl-ß-methylcholine chloride. A custom-made, dual-defibrillation catheter was placed with electrodes in the lateral RA, CS, and RSP. A separate defibrillation catheter was also placed in the RAA. ADFT characteristics of RAACS and 6 other single- or sequential-shock configurations were determined in random order by using biphasic, truncated-exponential waveforms in a multiple-reversal protocol. The delivered-energy, peak-voltage, and peak-current ADFTs for the sequential-shock configuration CSRSP/RARSP (0.53±0.31 J, 86±22 V, and 1.6±0.6 A, respectively) were significantly lower than those of RAACS (1.14±0.64 J, 157±34 V, and 2.5±1.1 A, respectively). The ADFT characteristics of RAACS and RACS were not significantly different, nor were those of CSRSP/RARSP and CSRSP/RAA RSP.

Conclusions— The ADFT of the standard RAACS configuration may be markedly reduced with an additional electrode situated at the RSP.

Key Words: defibrillation • atrium • electrophysiology

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