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Delayed conversion to sinus rhythm after direct-current countershock.

W F Duvernoy, D T Anbe

    Heart & Lung : the Journal of Critical Care
    |May 1, 1976
    PubMed
    Summary
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    Delayed electrical cardioversion for supraventricular arrhythmias can occur up to two minutes post-shock. Observe rhythm for this period before considering repeat DC countershock for successful conversion.

    Area of Science:

    • Cardiology
    • Electrophysiology

    Background:

    • Supraventricular arrhythmias necessitate electrical cardioversion.
    • DC countershock is a standard treatment for restoring normal sinus rhythm.

    Purpose of the Study:

    • To investigate delayed conversion to normal sinus rhythm after DC countershock for supraventricular arrhythmias.
    • To evaluate the optimal timing for repeat electrical cardioversion if initial attempts appear unsuccessful.

    Main Methods:

    • Retrospective analysis of 203 patients undergoing elective cardioversion for supraventricular arrhythmias between May 1972 and November 1974.
    • Detailed observation of cardiac rhythm following DC countershock, noting intervals to conversion.

    Main Results:

    • Five patients (2.5%) exhibited delayed conversion to normal sinus rhythm, occurring 4 to 105 seconds post-shock.

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  • One case demonstrated apparent atrial dissociation with persistent atrial fibrillation and simultaneous visible sinus P-waves.

    • Conclusions:

    • Delayed conversion after DC countershock is a recognized phenomenon in supraventricular arrhythmias.
    • If initial cardioversion appears to fail, a waiting period of up to two minutes is recommended before administering a repeat shock.