Temporary Atrial Electrode for the Treatment of Supraventricular Tachycardia After Cardiac Operations

Abstract

Background. Supraventricular tachycardia is a common postoperative complication early after cardiac operations. A temporary atrial patch electrode for low-energy atrial defibrillation was developed in 1992 and subsequently tested.Methods. The electrode first was tested and removed intraoperatively during open heart operations in 10 patients (phase I). After the intraoperative testing, the temporary atrial patch electrode was implanted in 20 patients for postoperative termination of spontaneous episodes of supraventricular tachycardia (phase II). When supraventricular tachycardia occurred, biphasic shocks (1.2 to 5 J) were applied and the atrial defibrillation thresholds were measured.Results. In phase I, the mean intraoperative atrial defibrillation threshold was 1.6 ± 1.4 J, with a mean shock impedance of 64 ± 7.3 Ω. In phase II, 6 of 20 patients (30%) had 7 episodes of atrial fibrillation (n = 6) and atrial flutter (n = 1) after operation. In 5 patients, the supraventricular tachycardia could be converted to a sinus (n = 5) or normofrequent atrioventricular rhythm (n = 1). The mean postoperative defibrillation threshold was 2.7 ± 2.1 J, with a mean shock impedance of 50.2 ± 6.8 Ω.Conclusions. The temporary atrial patch electrode allows low-energy defibrillation of episodes of atrial fibrillation. It may serve as an alternative therapeutic option for the treatment of supraventricular tachycardia.