BACKGROUND: The low shock energy used during internal atrial defibrillation may decrease the need for sedation during defibrillation with an implantable atrial defibrillator. METHODS AND RESULTS: The atrial defibrillator (Metrix Atrioverter) was implanted in 12 patients. During the in-hospital treatment of atrial fibrillation (AF) episodes, intravenous sedation was given only on patient request. The Atrioverter was programmed for ambulatory therapy in 4 patients. Efficacy, number of shocks delivered, and sedation requirements were recorded. A total of 393 shocks (1.8+/-1. 6 shocks/AF episode) were delivered to treat 213 AF episodes; 85 of 213 AF episodes (40%) were treated away from the hospital. Sinus rhythm was restored in 195 AF episodes (92%). Five patients never requested sedation. No sedation was needed for ambulatory-treated AF episodes. During the treatment of 26 of 213 AF episodes (12%), 75 shocks were delivered after patients received sedation. The number of shocks required to treat an AF episode determined the need for sedation (4.3+/-2.1 shocks for AF episodes requiring sedation versus 2+/-1 shocks for AF episodes requiring no sedation; P<0.001). These additional shocks were needed to treat immediate reinitiation of AF (14 episodes) or initial failure to cardiovert (4 episodes). For 8 AF episodes, sedation was requested before the first shock. CONCLUSIONS: This study suggests that, in a selected group of patients, AF can be treated with Atrioverter therapy without sedation. Successful ambulatory treatment of AF episodes with the Atrioverter, programmed to deliver </=2 shocks, did not require sedation. When multiple shocks were required to treat an AF episode, the need for sedation increased and included patients initially not requesting sedation.
BACKGROUND: The low shock energy used during internal atrial defibrillation may decrease the need for sedation during defibrillation with an implantable atrial defibrillator. METHODS AND RESULTS: The atrial defibrillator (Metrix Atrioverter) was implanted in 12 patients. During the in-hospital treatment of atrial fibrillation (AF) episodes, intravenous sedation was given only on patient request. The Atrioverter was programmed for ambulatory therapy in 4 patients. Efficacy, number of shocks delivered, and sedation requirements were recorded. A total of 393 shocks (1.8+/-1. 6 shocks/AF episode) were delivered to treat 213 AF episodes; 85 of 213 AF episodes (40%) were treated away from the hospital. Sinus rhythm was restored in 195 AF episodes (92%). Five patients never requested sedation. No sedation was needed for ambulatory-treated AF episodes. During the treatment of 26 of 213 AF episodes (12%), 75 shocks were delivered after patients received sedation. The number of shocks required to treat an AF episode determined the need for sedation (4.3+/-2.1 shocks for AF episodes requiring sedation versus 2+/-1 shocks for AF episodes requiring no sedation; P<0.001). These additional shocks were needed to treat immediate reinitiation of AF (14 episodes) or initial failure to cardiovert (4 episodes). For 8 AF episodes, sedation was requested before the first shock. CONCLUSIONS: This study suggests that, in a selected group of patients, AF can be treated with Atrioverter therapy without sedation. Successful ambulatory treatment of AF episodes with the Atrioverter, programmed to deliver </=2 shocks, did not require sedation. When multiple shocks were required to treat an AF episode, the need for sedation increased and included patients initially not requesting sedation.
Authors: Hamza Sunman; Kudret Aytemir; Hikmet Yorgun; Uğur Canpolat; Muhammet Ulvi Yalçin; Naresh Maharjan; Serkan Asil; Levent Şahiner; Barış Kaya; Necla Özer; Ali Oto Journal: Ann Noninvasive Electrocardiol Date: 2015-06-18 Impact factor: 1.468