Initial experience with single lead intracardial cardioversion for refractory atrial fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Chronic atrial fibrillation (AF) is a prevalent arrhythmia linked to significant morbidity.
• Trans-thoracic electric cardioversion (TTCV) is standard for pharmacological refractory AF but fails in 10-30% of patients.

Purpose of the Study:

• To evaluate the safety and efficacy of low-energy intracardiac cardioversion (ICCV) using a novel balloon-guided single-catheter system.
• To assess ICCV as an alternative for patients unresponsive to conventional TTCV.

Main Methods:

• A single flow-guided atrial cardioversion catheter was employed for ICCV in patients who failed TTCV.
• Low-energy biphasic shocks (6-15 J) were administered, with adjunctive intravenous amiodarone and/or post-shock overdrive pacing (AOO) if needed.

Main Results:

• Initial successful conversion to sinus rhythm (SR) was achieved in 90% (14/16) of patients.
• SR was preserved long-term (1-3 months) in 56% (9/16) of patients, often with oral amiodarone.
• The procedure demonstrated an excellent safety profile, with no adverse events reported, even under anticoagulation.

Conclusions:

• ICCV with a single atrial cardioversion catheter is a safe and effective strategy for restoring SR in patients refractory to TTCV.
• Procedure outcomes are influenced by antiarrhythmic drug therapy, patient compliance, and selection.
• Long-term follow-up results are comparable to existing cardioversion studies.