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Marked reduction in atrial defibrillation thresholds with repeated internal cardioversion
1Medizinische Klinik, Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany.
Journal of the American College of Cardiology
|November 7, 1999
Summary
Repeated internal cardioversion significantly reduces atrial defibrillation energy needs in patients with atrial fibrillation (AF). Shortening AF duration may expand eligibility for implantable atrial defibrillators.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Internal cardioversion is effective for chronic atrial fibrillation (AF).
- High energy requirements may exclude some patients from receiving implantable atrial defibrillators.
Purpose of the Study:
- To assess atrial defibrillation thresholds using repeated internal cardioversion in AF patients.
- To determine if repeated cardioversion impacts energy requirements and patient eligibility for implantable devices.
Main Methods:
- Internal shocks delivered via right atrium and coronary sinus or pulmonary artery electrodes.
- Eighty patients with chronic AF underwent initial cardioversion; 18 had repeated cardioversion after AF recurrence.
- Patients received sotalol post-cardioversion.
Main Results:
- The mean defibrillation threshold decreased significantly from 6.67 J to 3.83 J with repeated cardioversion (p=0.003).
- Reduced AF duration before cardioversion was the sole significant predictor of lower energy requirements.
- Sedation and pain scores also decreased significantly with repeated cardioversion.
Conclusions:
- Reducing atrial fibrillation duration significantly lowers defibrillation energy needs for internal cardioversion.
- This finding may broaden eligibility for implantable atrial defibrillators in patients with initially high thresholds.