Novel passive implantable atrial defibrillator using transcutaneous radiofrequency energy transmission successfully cardioverts atrial fibrillation

G Manoharan, N Evans, B Kidwai, D Allen, JMCC Anderson, J Adgey

    Research output: Contribution to journalArticle

    10 Citations (Scopus)

    Abstract

    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.
    LanguageEnglish
    Pages1382-1388
    JournalCirculation
    Volume108
    Issue number11
    DOIs
    Publication statusPublished - Sep 2003

    Fingerprint

    Electric Countershock
    Implantable Defibrillators
    Atrial Fibrillation
    Defibrillators
    Shock
    Atrial Appendage
    Equipment and Supplies
    Skin
    Coronary Sinus
    Feasibility Studies
    Pulse
    Animal Models

    Keywords

    • arrhythmia
    • fibrillation
    • cardioversion

    Cite this

    Manoharan, G ; Evans, N ; Kidwai, B ; Allen, D ; Anderson, JMCC ; Adgey, J. / Novel passive implantable atrial defibrillator using transcutaneous radiofrequency energy transmission successfully cardioverts atrial fibrillation. In: Circulation. 2003 ; Vol. 108, No. 11. pp. 1382-1388.
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    abstract = "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.",
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    Novel passive implantable atrial defibrillator using transcutaneous radiofrequency energy transmission successfully cardioverts atrial fibrillation. / Manoharan, G; Evans, N; Kidwai, B; Allen, D; Anderson, JMCC; Adgey, J.

    In: Circulation, Vol. 108, No. 11, 09.2003, p. 1382-1388.

    Research output: Contribution to journalArticle

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    T1 - Novel passive implantable atrial defibrillator using transcutaneous radiofrequency energy transmission successfully cardioverts atrial fibrillation

    AU - Manoharan, G

    AU - Evans, N

    AU - Kidwai, B

    AU - Allen, D

    AU - Anderson, JMCC

    AU - Adgey, J

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    N2 - 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.

    AB - 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.

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