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[Atrial fibrillation, restoration of sinus rhythm]
J Clémenty1, L Gencel, F Poquet
1Université de Bordeaux, hôpital cardiologique du Haut-Lévêque, Pessac.
Insights
Cardioversion aims to restore normal heart rhythm in atrial fibrillation, preventing complications. Long-term success depends on maintaining sinus rhythm, with amiodarone and electrical shock as key interventions.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Atrial fibrillation poses risks of hemodynamic instability and thromboembolic events.
- Restoring sinus rhythm is crucial for managing atrial fibrillation complications.
- Anticoagulation is a mandatory prerequisite for cardioversion, except in emergencies.
Purpose of the Study:
- To outline the recommended strategies for cardioversion in atrial fibrillation.
- To discuss pharmacological and electrical methods for converting atrial fibrillation to sinus rhythm.
- To highlight the importance of maintaining sinus rhythm post-cardioversion.
Main Methods:
- Pharmacological cardioversion using oral or intravenous antiarrhythmic drugs, with amiodarone as the preferred agent.
- Electrical cardioversion via external direct current shock, influenced by energy, electrode placement, and thoracic impedance.
- Internal electrical defibrillation using endocavitary catheters or esophageal approaches with minimal complications.
Main Results:
- Cardioversion is effective in restoring sinus rhythm for many patients.
- Success rates of electrical cardioversion are contingent upon technical factors and patient characteristics.
- Long-term maintenance of sinus rhythm remains the primary challenge after successful cardioversion.
Conclusions:
- Cardioversion is a recommended procedure for atrial fibrillation to prevent adverse outcomes.
- The choice of cardioversion method (pharmacological or electrical) depends on patient factors and clinical context.
- If sinus rhythm cannot be sustained, rhythm-slowing therapy is indicated instead of further cardioversion attempts.
Abstract:
Conversion to sinus rhythm (cardioversion) is recommended to prevent the haemodynamic and thromboembolic complications of atrial fibrillation. Prior anticoagulation is compulsory except in emergencies. The duration of anticoagulant therapy depends on the terrain and chronicity of the arrhythmia. Cardioversion may be proposed for the majority of patients in whom it is thought that sinus rhythm can be maintained by appropriate therapy. It may be carried out pharmacologically by oral or intravenous antiarrhythmic therapy. Amiodarone is the drug of choice. Cardioversion may also be carried out by external or internal direct current shock. The success rate of external electrical defibrillation depends on the energy administered, the site of the electrodes and a number of factors related to thoracic impedence. Internal electrical defibrillation may be performed with an endocavitary catheter or by the oesophageal approach, with few complications. The main problem resides in maintaining sinus rhythm in the long term. When this is not possible, cardioversion is useless, and therapy to slow the cardiac rhythm should be instituted.