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(Circulation. 2000;102:1407.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Initial Clinical Experience With Ambulatory Use of an Implantable Atrial Defibrillator for Conversion of Atrial Fibrillation

Emile G. Daoud, MD; Carl Timmermans, MD; Chris Fellows, MD; Robert Hoyt, MD; Robert Lemery, MD; Kathy Dawson, PhD; Gregory M. Ayers, MD, PhD; for the Metrix Investigators

From Riverside-Methodist Hospital, Columbus, Ohio (E.G.D.); Academic Hospital Maastricht, the Netherlands (C.T.); Virginia Mason Medical Center, Seattle, Wash (C.F.); Iowa Heart Institute, Des Moines, Iowa (R.H.); Rhode Island Hospital, Providence, RI (R.L.); and InControl/Guidant, Inc, Redmond, Wash/St Paul, Minn (K.D., G.M.A.).

Correspondence to Emile Daoud, MD, MidOhio Cardiology Research, 3545 Olentangy River Rd, Room 325, Columbus, OH 43214. E-mail egd{at}mocc.cc

Background—A recent study has shown that the implantable atrial defibrillator can restore sinus rhythm in patients with recurrent atrial fibrillation when therapy was delivered under physician observation. The objective of this study was to evaluate the safety and efficacy of ambulatory use of the implantable atrial defibrillator.

Methods and Results—An atrial defibrillator was implanted in 105 patients (75 men; mean age, 59±12 years) with recurrent, symptomatic, drug-refractory atrial fibrillation. After successful 3-month testing, patients could transition to ambulatory delivery of shock therapy. Patients completed questionnaires regarding shock therapy discomfort and therapy satisfaction using a 10-point visual-analog scale (1 represented "not at all," 10 represented "extremely") after each treated episode of atrial fibrillation. During a mean follow-up of 11.7 months, 48 of 105 patients satisfied criteria for transition and received therapy for 275 episodes of atrial fibrillation. Overall shock therapy efficacy was 90% with 1.6±1.2 shocks delivered per episode (median, 1). Patients rated shock discomfort as 5.2±2.4 for successful therapy and 4.2±2.2 for unsuccessful therapy (P>0.05). The satisfaction score was higher for successful versus unsuccessful therapy (3.4±3.3 versus 8.7±1.3, P<0.05). There was no ventricular proarrhythmia observed throughout the course of this study.

Conclusions—Ambulatory use of an implantable atrial defibrillator can safely and successfully convert most episodes of atrial fibrillation, often requiring only a single shock. Successful therapy is associated with high satisfaction and only moderate discomfort.

Key Words: defibrillation • shock • cardioversion • outpatient therapy

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