[Evaluation of typical atrial flutter cycle duration during electric stimulation cardioversion]

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Atrial flutter (AF) and ischemic heart disease (IHD) present significant clinical challenges.
• Restoring sinus rhythm is crucial for managing these conditions.

Purpose of the Study:

• To evaluate the efficacy of transesophageal electric cardiac stimulation (TEECS) for restoring sinus rhythm in patients with AF.
• To investigate the relationship between AF cycle duration and TEECS outcomes.
• To determine the optimal timing for antiarrhythmic therapy (AAT) in conjunction with TEECS.

Main Methods:

• 225 patients with AF and IHD or postmyocarditic cardiosclerosis underwent TEECS.
• Patients were stratified into three groups based on AF cycle duration (<220 ms, 220-259 ms, ≥260 ms).
• No pre-TEECS AAT was administered; AAT use during or after TEECS was analyzed.

Main Results:

• TEECS was performed in 225 patients, with a history of arrhythmia averaging 7.1 years.
• A significant inverse relationship was observed between AF cycle duration and TEECS efficacy, influenced by age, IHD, conduction abnormalities, and pulmonary pathology.
• For AF cycle duration <220 ms, procainamide use during TEECS was common, suggesting pre-TEECS AAT benefit.
• For AF cycle duration >260 ms, AAT post-stimulation (Class I medications) was safer and more effective than pre-treatment to avoid proarrhythmia.

Conclusions:

• TEECS is a viable option for restoring sinus rhythm in specific AF patient populations.
• AF cycle duration is a critical factor influencing TEECS success.
• Personalized AAT strategies, considering timing relative to TEECS based on AF cycle duration, are essential for maximizing efficacy and safety.