Determinants of first-shock success for atrial implantable cardioverter defibrillators

Charles D Swerdlow; David Schwartzman; Robert Hoyt; Steven J Bailin; Jodi L Koehler; Eduardo N Warman; Worldwide Model 7250 AF-Only Investigators

doi:10.1046/j.1540-8167.2002.00347.x

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Determinants of first-shock success for atrial implantable cardioverter defibrillators

Journal article

Peer reviewed

Determinants of first-shock success for atrial implantable cardioverter defibrillators

Charles D Swerdlow, David Schwartzman, Robert Hoyt, Steven J Bailin, Jodi L Koehler, Eduardo N Warman and Worldwide Model 7250 AF-Only Investigators

Journal of cardiovascular electrophysiology, Vol.13(4), pp.347-354

04/2002

DOI: 10.1046/j.1540-8167.2002.00347.x

PMID: 12033351

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Abstract

The aim of this study was to identify determinants of first-shock success for defibrillation of spontaneous atrial fibrillation (AF) in ambulatory patients with an atrial implantable cardioverter defibrillator (ICD). The determinants of first-shock success in ambulatory patients with atrial ICDs are unknown. We used the generalized estimating equation method to analyze determinants of first-shock success in 50 consecutive atrial ICD recipients in whom DFT+ (weakest shock that defibrillates on two consecutive trials) was determined at implant and spontaneous AF was shocked with shock strength > or = 2 x DFT+. DFT+ was 6.2 +/- 3.1 J. Of 470 first shocks, 407 were successful (generalized estimating equation 85%, confidence interval 79% to 90%). Determinants of first-shock success were use of coronary sinus electrode (univariate P = 0.02; multivariate P < 0.001, relative risk 5.0), absence of a Class III antiarrhythmic drug (univariate P = 0.06; multivariate P < 0.001, relative risk 3.2), absence of early recurrence of atrial fibrillation (ERAF; univariate P = 0.06; multivariate P = 0.02, relative risk 2.9), and longer duration of AF prior to shock > or = 3 hours (univariate: P = 0.02; multivariate P = NS). Sinus rhythm >1 minute persisted after 93% of first shocks in patients without documented ERAF but after only 58% of shocks in patients with documented ERAF (P < 0.001). Reducing ERAF is critical to achieving a clinically acceptable rate of persistent sinus rhythm after first shocks. For first shocks > or = 2 x DFT +, success is not increased by programming stronger shocks. Early cardioversion does not increase first-shock success.

Ambulatory Care - methods

Anti-Arrhythmia Agents - therapeutic use

Atrial Fibrillation - therapy

Atrial Flutter - therapy

Combined Modality Therapy - methods

Defibrillators, Implantable

Electric Countershock - methods

Female

Follow-Up Studies

Humans

Male

Middle Aged

Multicenter Studies as Topic

Recurrence

Reproducibility of Results

Risk Factors

Sensitivity and Specificity

Statistics as Topic

Treatment Outcome

Details

Title: Subtitle: Determinants of first-shock success for atrial implantable cardioverter defibrillators
Creators: Charles D Swerdlow - Cedars-Sinai Medical Center
David Schwartzman - University of Pittsburgh Medical Center
Robert Hoyt - †Iowa Heart Center, Des Moines, Iowa
Steven J Bailin - †Iowa Heart Center, Des Moines, Iowa
Jodi L Koehler - Medtronic
Eduardo N Warman - Medtronic
Worldwide Model 7250 AF-Only Investigators
Resource Type: Journal article
Publication Details: Journal of cardiovascular electrophysiology, Vol.13(4), pp.347-354
DOI: 10.1046/j.1540-8167.2002.00347.x
PMID: 12033351
ISSN: 1045-3873
eISSN: 1540-8167
Language: English
Date published: 04/2002
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984360058102771

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