{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T12:32:52Z","timestamp":1749213172172},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"25","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1998,6,30]]},"abstract":"<jats:p>\n            <jats:italic>Background<\/jats:italic>\n            \u2014This study tested the ability of sequential shocks delivered through dual-current pathways to lower the atrial defibrillation threshold (ADFT) compared with a biphasic shock through a standard single-current pathway.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            \u2014Electrodes were positioned in the right atrial appendage (RA), left subclavian vein (LSV), proximal coronary sinus (CSos), and distal coronary sinus (DCS) in 14 patients with chronic atrial fibrillation (170\u00b1185 days). Using a step-up protocol, we compared ADFTs for a single-current pathway (RA\u2192DCS) that used a single 7.5\/2.5-ms biphasic shock from a 150-\u03bcF capacitor with those for a dual-current pathway system (RA\u2192DCS followed by CSos\u2192LSV) using sequential 7.5\/2.5-ms biphasic shocks with capacitor discharge waveforms for 150-\u03bcF and 600-\u03bcF capacitors. Both dual-current pathway configurations (2.0\u00b10.4 J for 150-\u03bcF capacitance, 2.4\u00b10.5 J for 600-\u03bcF capacitance) had a significantly lower ADFT than the single-current pathway (5.1\u00b11.8 J). Whereas the dual-current pathway with 150-\u03bcF capacitor shocks had a significantly lower energy threshold, there was no statistical difference in terms of leading-edge voltage compared with the dual-current pathway with 600-\u03bcF capacitance shocks. There were no ventricular arrhythmias induced with appropriately synchronized shocks.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014For internal atrial defibrillation in humans, sequential biphasic waveforms delivered over dual-current pathways resulted in a markedly reduced (&gt;50% reduction) ADFT compared with a single shock over a single-current pathway.\n          <\/jats:p>","DOI":"10.1161\/01.cir.97.25.2527","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:41:02Z","timestamp":1339461662000},"page":"2527-2535","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Marked Reduction in Internal Atrial Defibrillation Thresholds With Dual-Current Pathways and Sequential Shocks in Humans"],"prefix":"10.1161","volume":"97","author":[{"given":"Randolph A. 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