Synchronised cardioversion for chronic atrail fibrillation

To determine whether elective cardioversion was successful in establishing sinus rhythm in patients with chronic atrial fibrillation and the energy used for the cardioversion using a monophasic defibrillator.

This is a retrospective descriptive study.

Intensive care unit of the National Cardiothoracic Centre, Korle-bu Teaching Hospital.

Twelve consecutive patients referred by physicians with chronic atrial fibrillation which had not responded appropriately to pharmacological agents.

Using the intensive care admissions and discharge register and report book, the patients case notes were retrieved. The pre-cardioversion echocardiography diagnosis and drugs were noted. The results of cardioversion, and the current rhythm status were also reviewed.

There were twelve elective cardioversions for chronic atrial fibrillation during the period under investigation. All the patients were on warfarin with INR-2.2-2.8. Eight of the patients had initial echocardiographic evidence of thrombi in the left atrium. Sinus rhythm was established in 9(75%) of the patients. The mean energy used for the cardioversion was 384.4+/-167.7J. Of the 3 with failed cardioversion, one was later successfully cardioverted to sinus rhythm. On review, 9(75%) of the patients are still in sinus rhythm 6 months to 15 months after cardioversion. Six of these patients continue with oral amiodarone however.

Synchronized cardioversion for chronic atrial fibrillation is safe and may be successful after failure of pharmacologic cardioversion in patients where sinus rhythm is desirable.