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Related Experiment Videos

Transoesophageal versus transchest DC cardioversion

D J Cochrane1, D J McEneaney, J M Anderson

  • 1Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast.

The Quarterly Journal of Medicine
|August 1, 1993
PubMed
Summary

Transoesophageal cardioversion offers a successful alternative to transchest cardioversion for atrial fibrillation. This method uses lower energy and provides a low-impedance pathway, achieving comparable success rates without esophageal complications.

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Atrial fibrillation management often requires electrical cardioversion.
  • Transchest cardioversion is the standard but can require high energy levels.
  • Alternative methods for cardioversion are being explored to improve efficacy and reduce energy requirements.

Purpose of the Study:

  • To compare the efficacy and safety of transoesophageal cardioversion with transchest cardioversion in patients with atrial fibrillation.
  • To evaluate energy requirements and success rates for both cardioversion approaches.

Main Methods:

  • A randomized trial involving 100 consecutive patients with atrial fibrillation.
  • Patients were assigned to either transoesophageal cardioversion or transchest cardioversion.
  • Energy levels were escalated as needed, with specific protocols for each group.

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Main Results:

  • Both transoesophageal and transchest cardioversion achieved similar overall success rates (72% vs. 82%, p=NS).
  • Transoesophageal cardioversion was more successful at lower energy levels (≤100 J) (72% vs. 34%, p<0.05).
  • Median total energy and mean peak current were significantly lower in the transoesophageal group (180 J, 21.7 A) compared to the transchest group (350 J, 27.3 A) (p<0.05).

Conclusions:

  • Transoesophageal cardioversion is as effective as the transchest route for atrial fibrillation.
  • The transoesophageal approach provides a low-impedance, low-energy pathway for cardioversion.
  • No esophageal complications were observed, suggesting a favorable safety profile.