ST-segment changes after direct current external cardioversion for atrial fibrillation. Incidence, characteristics
Philippe Rumeau1, Joelle Fourcade, Alexandre Duparc
1Fédération de Cardiologie, University Hospital Rangueil, Toulouse, France.
International Journal of Cardiology
|December 29, 2009
Summary
Transient ST-segment changes after direct current (DC) shock for atrial fibrillation are common but clinically insignificant. Monophasic shocks, propofol, and increased CRP predict ST elevation, while biphasic shocks and low ejection fraction predict ST depression.
Area of Science:
- Cardiology
- Electrophysiology
- Critical Care Medicine
Background:
- Transient ST-segment changes following direct current (DC) shock for cardioversion are not well understood.
- Predictive factors and incidence of these electrocardiographic (ECG) changes require further investigation.
Purpose of the Study:
- To investigate the incidence, characteristics, and predictive factors of transient ST-segment changes after external DC cardioversion for atrial fibrillation (AF).
Main Methods:
- Prospective study of 91 patients undergoing external cardioversion for AF.
- ECG assessment for ST elevation/depression immediately post-DC shock.
- Correlation analysis with DC shock parameters, clinical, echocardiographic, biological data, and medications.
Main Results:
- 48% incidence of ST-segment changes (35% elevation, 13% depression) post-DC shock.
- ST elevation linked to monophasic shocks, propofol, and elevated C-reactive protein (CRP).
- ST depression associated with biphasic shocks and reduced ejection fraction.
Conclusions:
- ST-segment changes post-cardioversion are frequent, transient, and clinically insignificant.
- Monophasic vs. biphasic shock configuration, propofol, ejection fraction, and CRP are key predictors.
- These findings aid in understanding ECG changes after DC cardioversion.
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