Philip A.R. Spurrell

Psychosocial aspects of patient-activated atrial defibrillation.

Introduction: The atrial defibrillator empowers patients to cardiovert themselves from atrial arrhythmias at a time that is socially and physically acceptable, thereby preventing hospitalization. The long‐term psychosocial effects of repeated use of the patient‐activated atrial defibrillator at home are unknown.

Does sinus rhythm beget sinus rhythm? Long-term follow-up of the patient activated atrial defibrillator.

The aim of this study was to determine the effect of early patient activated cardioversion of atrial fibrillation (AF) using the atrial defibrillator on recurrence of AF. Fifteen patients, mean age 63 ± 14 years, 80% men, with drug‐resistant persistent AF were implanted with the Jewel AF atrial defibrillator. All patients performed self‐administered cardioversion for AF recurrences. Over a 2 year follow‐up, 238 patient‐activated cardioversions were performed in 14 patients. Sinus rhythm was restored on every occasion with 96% of episodes terminating with a single shock. The median time from AF onset to patient awareness of symptoms was 2.5 hours. The median time from onset of symptoms to cardioversion was 3.5 hours. Comparison of the first and second six month period following implant showed a nonsignificant increase in mean total AF duration (75.7 ± 107.8 hours vs 146.6 ± 194.1 hours, P = 0.28). Two patients (13%) had a decreasing frequency of AF recurrences. The majority continued to have regular recurrences of AF. The atrial defibrillator is an extremely effective method of restoring sinus rhythm in patients with persistent AF. Regular early use of the atrial defibrillator, increased the duration of sinus rhythm in a minority of patients during long‐term follow‐up. Most patients had regular recurrences of AF requiring patient‐activated cardioversion. (PACE 2004; 27:175–181)

Reversal of tachycardiomyopathy by the atrial defibrillator

It is increasingly recognized that the long-term consequences of atrial fibrillation(AF) are not benign. Chronic AF is associated with an increased mortality and a reduced life expectancy, believed to be as a consequence of thromboembolic disease (particularly stroke) and the onset of heart failure w1,2x. AF can result in both rapid and irregular ventricular rates and the development of atrial fibrillation-induced tachycardiomyopathy w3x. The evolution of the patient activated atrial defibrillator has empowered patients to ‘take charge’ of their condition and deliver an endocardial synchronised shock to restore sinus rhythm soon after the onset of arrhythmia w4x. We report a case of a patient with recurrent AF who presented with mild heart failure and reduced ejection fraction (EF) in whom normal left ventricular function returned and was maintained after repeated use of the atrial defibrillator.