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Higher energy synchronized external direct current cardioversion for refractory atrial fibrillation
W Saliba1, N Juratli, M K Chung
1Department of Cardiology, Section of Cardiac Electrophysiology and Pacing, The Cleveland Clinic Foundation, Ohio 44124, USA.
Journal of the American College of Cardiology
|December 10, 1999
Summary
Higher energy cardioversion effectively restores sinus rhythm in atrial fibrillation patients resistant to standard treatment. This safe and effective method avoids complications and may be an alternative to internal cardioversion.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Standard external electrical cardioversion is ineffective in 5-30% of AF patients.
- Refractory AF requires alternative treatment strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of higher energy synchronized cardioversion.
- To assess a novel approach for patients with AF refractory to standard direct current (DC) cardioversion.
Main Methods:
- Included 55 patients with AF refractory to at least two 360 J cardioversion attempts.
- Utilized two external defibrillators to deliver a synchronized 720 J total energy.
- Applied R-2 patches in the anteroposterior position.
Main Results:
- Achieved sinus rhythm in 84% (46/55) of patients.
- No major complications, hemodynamic compromise, or cerebrovascular accidents occurred.
- 39% of successfully cardioverted patients maintained sinus rhythm at a mean 2.1-month follow-up.
Conclusions:
- Higher energy cardioversion is safe and effective for refractory AF.
- This method offers a viable alternative to internal cardioversion.
- It avoids the need to withhold anticoagulation therapy.