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DC cardioversion and coronary artery spasm.

S B Siwach, V K Katyal

The Journal of the Association of Physicians of India

|August 1, 1989

Summary

Direct current shock for atrial fibrillation can cause ST segment elevation due to coronary artery spasm. This rare complication highlights potential risks associated with electrical cardioversion.

Area of Science:

Cardiology
Electrophysiology
Medical Complications

Background:

Atrial fibrillation is a common cardiac arrhythmia requiring treatment.
Electrical cardioversion using direct current (DC) shock is a standard treatment for atrial fibrillation.
ST segment elevation on electrocardiogram (ECG) typically indicates myocardial ischemia or infarction.

Observation:

A 55-year-old male patient experienced significant ST segment elevation on ECG after undergoing DC shock for lone atrial fibrillation.
The ST segment elevation was transient and not associated with other signs of acute coronary syndrome.

Findings:

The observed ST segment elevation following DC shock is hypothesized to be caused by coronary artery spasm.
This suggests a potential, albeit rare, complication of direct current electrical stimulation on coronary arteries.

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The mechanism may involve direct electrical effects or autonomic nervous system responses triggered by the shock.

Implications:

Clinicians should be aware of this potential complication during and after electrical cardioversion.
Distinguishing this artifact from true ischemic events is crucial for appropriate patient management.
Further research may elucidate the precise mechanism and incidence of DC shock-induced coronary artery spasm.