{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T08:47:46Z","timestamp":1758444466625,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[1998,1,23]]},"published-print":{"date-parts":[[1998,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate the defibrillator waiting time (time between the recognition of atrial fibrillation and the actual shock) by studying paroxysmal atrial fibrillation episodes with RR intervals shorter than a certain limit (that is, episodes during which defibrillation should not be attempted).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec sec-type=\"methods\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Long term 24 hour Holter recordings from a digoxin <jats:italic>v<\/jats:italic> placebo crossover study in patients with paroxysmal atrial fibrillation were analysed. In all, 23 recordings with atrial fibrillation episodes of at least 1000 ventricular cycles and with &lt;\u200920% Holter artefacts or noise were used (11 recorded on placebo and 12 on digoxin). For each recording, the mean (\u201cmean waiting time\u201d) and maximum (\u201cmaximum waiting time\u201d) duration of continuous sections of atrial fibrillation episodes with all RR intervals shorter than a certain threshold were evaluated, ranging the threshold from 400 to 1000\u2009ms in 10\u2009ms steps. For each threshold, the mean and maximum waiting times were compared between recordings on placebo and on digoxin.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Both the mean and maximum waiting times increased exponentially with increasing threshold. Practically acceptable mean waiting times less than one minute were observed with thresholds below 600\u2009ms. There were no significant differences in mean waiting times and maximum waiting times between recordings on placebo and digoxin, and only a trend towards shorter waiting times on digoxin.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Introduction of a minimum RR interval threshold required to deliver atrial defibrillation leads to practically acceptable delays between atrial fibrillation recognition and the actual shock. These delays are not prolonged by digoxin treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/hrt.79.5.497","type":"journal-article","created":{"date-parts":[[2014,10,22]],"date-time":"2014-10-22T15:31:45Z","timestamp":1413991905000},"page":"497-501","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Distribution of fast heart rate episodes during paroxysmal atrial fibrillation"],"prefix":"10.1136","volume":"79","author":[{"given":"K","family":"Hnatkova","sequence":"first","affiliation":[{"name":"aDepartment of Cardiological Sciences, St George\u2019s Hospital Medical School, London, UK, \n\nbInControl Inc, Redmond, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F D","family":"Murgatroyd","sequence":"additional","affiliation":[{"name":"aDepartment of Cardiological Sciences, St George\u2019s Hospital Medical School, London, UK, \n\nbInControl Inc, Redmond, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C A","family":"Alferness","sequence":"additional","affiliation":[{"name":"aDepartment of Cardiological Sciences, St George\u2019s Hospital Medical School, London, UK, \n\nbInControl Inc, Redmond, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A J","family":"Camm","sequence":"additional","affiliation":[{"name":"aDepartment of Cardiological Sciences, St George\u2019s Hospital Medical School, London, UK, \n\nbInControl Inc, Redmond, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Malik","sequence":"additional","affiliation":[{"name":"aDepartment of Cardiological Sciences, St George\u2019s Hospital Medical School, London, UK, \n\nbInControl Inc, Redmond, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1998,5,1]]},"reference":[{"key":"2025092000424038000_79.5.497.1","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1111\/j.1540-8159.1997.tb05492.x","article-title":"Hemodynamic effects and clinical determinants of defibrillation threshold for transvenous atrial defibrillation using biatrial biphasic shocks in patients with chronic atrial fibrillation.","volume":"20","author":"Lok","year":"1997","journal-title":"PACE"},{"key":"2025092000424038000_79.5.497.2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/00001573-199701000-00003","article-title":"The future role of defibrillators in the management of atrial fibrillation.","volume":"12","author":"Ayers","year":"1997","journal-title":"Curr Opin Cardiol"},{"key":"2025092000424038000_79.5.497.3","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1540-8159.1997.tb04847.x","article-title":"Initial clinical experience with an implantable human atrial defibrillator.","volume":"20","author":"Lau","year":"1997","journal-title":"PACE"},{"key":"2025092000424038000_79.5.497.4","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/j.1540-8167.1997.tb00809.x","article-title":"Ventricular fibrillation resulting from synchronized internal atrial defibrillation in a patient with ventricular preexcitation.","volume":"8","author":"Barold","year":"1997","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2025092000424038000_79.5.497.5","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1111\/j.1540-8159.1994.tb01462.x","article-title":"Initial experience with intracardiac atrial defibrillation in patients with chronic atrial fibrillation.","volume":"17","author":"Alt","year":"1994","journal-title":"PACE"},{"key":"2025092000424038000_79.5.497.6","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1161\/01.CIR.89.1.413","article-title":"Ventricular proarrhythmic effects of ventricular cycle length and shock strength in a sheep model of transvenous atrial defibrillation.","volume":"89","author":"Ayers","year":"1994","journal-title":"Circulation"},{"key":"2025092000424038000_79.5.497.7","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1161\/01.CIR.87.5.1673","article-title":"Internal cardioversion of atrial fibrillation in sheep.","volume":"87","author":"Cooper","year":"1993","journal-title":"Circulation"},{"key":"2025092000424038000_79.5.497.8","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00555-5"},{"key":"2025092000424038000_79.5.497.9","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.70.4.304"},{"key":"2025092000424038000_79.5.497.10","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1136\/bmj.309.6969.1631","article-title":"Cardiology. II: Treatment of heart failure and atrial fibrillation and arrhythmias.","volume":"309","author":"McMurray","year":"1994","journal-title":"BMJ"},{"key":"2025092000424038000_79.5.497.11","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)90353-E"},{"key":"2025092000424038000_79.5.497.12","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2710.1996.89475894.x"},{"key":"2025092000424038000_79.5.497.13","first-page":"478A","article-title":"CRAFT Investigators: The results of CRAFT-1: a multi-center, double-blind, placebo-controlled crossover study of digoxin in symptomatic paroxysmal atrial fibrillation [abstract].","volume":"21","author":"Murgatroyd","year":"1993","journal-title":"J Am Coll Cardiol"},{"key":"2025092000424038000_79.5.497.14","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1111\/j.1540-8159.1995.tb06972.x","article-title":"Identification of atrial fibrillation episodes in ambulatory electrocardiographic recordings: validation of a method for obtaining labelled R-R interval files.","volume":"18","author":"Murgatroyd","year":"1995","journal-title":"PACE"},{"key":"2025092000424038000_79.5.497.15","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780141903"},{"key":"2025092000424038000_79.5.497.16","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-114-7-573","article-title":"Digoxin for atrial fibrillation: a drug whose time has gone?","volume":"114","author":"Falk","year":"1991","journal-title":"Ann Intern Med"},{"key":"2025092000424038000_79.5.497.17","unstructured":"Coumel P (1990) Role of the autonomic nervous system in paroxysmal atrial fibrillation. in Atrial arrhythmias. 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