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(Circulation. 1998;98:833-834.)
© 1998 American Heart Association, Inc.

Editorial

Low-Energy Atrial Defibrillation

A Promising New Technique

Albert L. Waldo, MD

From the Department of Medicine, Case Western Reserve University, and University Hospitals of Cleveland, Cleveland, Ohio.

Correspondence to Albert L. Waldo, MD, Division of Cardiology, Lakeside 5038, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106. E-mail alw2@po.cwru.edu

Key Words: Editorials • atrial defibrillation • open heart surgery • atrial fibrillation

Temporary epicardial wire electrodes placed during open heart surgery for potential diagnostic and/or therapeutic use in patients in the immediate postoperative period have been used safely and effectively as part of standard care for a long time.^{1 2 3 4} We have also known that synchronized delivery of a low-energy DC shock for cardioversion of atrial fibrillation is very effective.^{5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21} With the presentation by Liebold et al²² of the study of 100 consecutive patients undergoing open heart surgery, we now have the demonstration of a new clinical application of both the use of temporary epicardial atrial wire electrodes and low-energy DC cardioversion of atrial fibrillation. The article by Liebold et al²² is actually about 2 things. One is a new therapeutic modality in the treatment of atrial fibrillation in the period immediately after open heart surgery. The other is the efficacy, safety, and tolerance of so-called low-energy atrial defibrillation.

It is widely recognized that atrial fibrillation is a common and important problem in patients who have had open heart surgery. As recently summarized,²³ many studies have examined its potential cause(s), prevention, and treatment. Unfortunately, although these studies have provided some insights, the problem has abated little. Thus, according to the study by Liebold et al,²² the demonstration of a new, effective treatment, low-energy atrial defibrillation with temporary epicardial wire electrodes placed on each atrium, is most welcome. The technique, initially studied in an animal model,^{12 16} also permits standard use of epicardial wire electrodes for recording (diagnostic) and pacing (therapeutic and diagnostic) purposes, just . . . [Full Text of this Article]

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