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Transoesophageal versus transchest DC cardioversion
D J Cochrane1, D J McEneaney, J M Anderson
1Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast.
Insights
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.
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.
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.
Abstract:
Attempted cardioversion via the oesophagus (transoesophageal cardioversion) was compared with the transchest approach (transchest cardioversion) in a randomized trial of 100 consecutive patients with atrial fibrillation. For the transoesophageal group, 30, 50 and 100 J were delivered via an oesophageal electrode with subsequent 200 and 360 J transchest if required. For the transchest group, 50, 100, 200 and 360 J were delivered if required. In the transoesophageal group, 36/50 (72%) of patients cardioverted using the transoesophageal route alone, and in the transchest group, 41/50 (82%) of patients cardioverted (p = NS). First shock success was similar for the transoesophageal and transchest groups: 13/50 (26%) vs. 8/50 (16%) respectively. The mean number of shocks required to achieve successful cardioversion was identical for the transoesophageal and transchest groups (2.6). However, transoesophageal cardioversion was more successful than transchest cardioversion at energies < or = 100 J (36/50 [72%], and 17/50 [34%], p < 0.05). Median total energy for successful cardioversion was lower for patients in the transoesophageal group (180 J) than the transchest group (350 J) and mean peak current at successful cardioversion was also lower for patients in the transoesophageal group (21.7 A) than the transchest group (27.3 A) (p < 0.05). No oesophageal complications occurred. Thus, using an oesophageal electrode, cardioversion can be achieved as successfully as using the transchest route. The transoesophageal approach offers a low impedance, and consequently a low-energy pathway for cardioversion.