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CLINICAL STUDIES

Spontaneous episodes of atrial fibrillation after implantation of the Metrix Atrioverter: observations on treated and nontreated episodes

Carl Timmermans, MD^*, Samuel Lévy, MD, FACC, Gregory M. Ayers, MD, FACC, Werner Jung, MD, Luc Jordaens, MD^||, Marten Rosenqvist, MD^¶, Bernard Thibault, MD^#, John Camm, MD, FACC^**, Luz-Maria Rodriguez, MD^*, Hein J. J. Wellens, MD, FACC^* for the Metrix Investigators

^* Academic Hospital, Maastricht, the Netherlands
Hôpital Nord, Marseille, France
InControl, Inc., Redmond, Washington, USA
University of Bonn, Bonn, Germany
^|| University Hospital, Gent, Belgium
^¶ Karolinska Hospital, Stockholm, Sweden
^# Montreal Heart Institute, Quebec, Canada
^** St. George’s Hospital, London, United Kingdom

Manuscript received February 2, 1999; revised manuscript received December 3, 1999, accepted January 20, 2000.

Reprint requests and correspondence: Dr. Carl Timmermans, Department of Cardiology, Academic Hospital Maastricht, Cardiovascular Research Institute Maastricht, P. Debyelaan 25, P.O. Box 5800, Maastricht, The Netherlands
C.Timmermans{at}cardio.azm.nl

OBJECTIVES

We sought to evaluate the number and duration of device-treated and self-terminating, nontreated episodes of atrial fibrillation (AF) after implantation of the Metrix Atrioverter.

BACKGROUND

A recent study has shown that the Atrioverter can rapidly restore sinus rhythm in patients with AF; however, the effect of the device on the clinical course of the arrhythmia in these patients is unknown.

METHODS

The Atrioverter was implanted in 51 patients with symptomatic, recurrent, drug-refractory AF. The device was programmed to periodically monitor the cardiac rhythm. Defibrillation of AF episodes was performed under physician observation.

RESULTS

During a mean follow-up of 260 ± 144 days, 1,161 episodes of AF were observed during valid monitoring periods in 45 of 51 patients. Forty-one patients experienced 231 episodes for which they sought defibrillation therapy. The average duration of the treated episodes during valid monitoring periods (190 of 231 episodes in 39 of 41 patients) was significantly longer than that of the nontreated episodes (38 ± 44 vs. 10 ± 8 h; p < 0.05). The time between episodes requiring Atrioverter therapy increased, and the risk of having an episode requiring treatment decreased. No changes were observed in the number and duration of the short-lasting, nontreated episodes as time since implantation of the device increased.

CONCLUSIONS

In patients with symptomatic, recurrent, drug-refractory AF, the frequency of long-lasting episodes, which were treated under observation with repeated defibrillation using the Atrioverter, decreased. The number and duration of short-lasting, nontreated episodes did not change during the 20-month study period. The effect of ambulatory use of the device on the recurrence of short-lasting episodes needs to be evaluated.

Abbreviations and Acronyms   AF = atrial fibrillation

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