Related Experiment Videos
High energy transcatheter cardioversion for chronic, poorly tolerated atrial fibrillation
N F Forgione1, F Acquati, S I Caico
1Division of Cardiology, General Hospital of Varese, Italy.
Insights
High energy transcatheter cardioversion effectively restored sinus rhythm in patients with chronic atrial fibrillation (AF). This safe procedure offers an alternative to AV node ablation, avoiding pacemakers and embolic risks.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Chronic atrial fibrillation (AF) significantly impacts patient well-being, often proving poorly tolerated.
- Patients frequently experience failed external cardioversion attempts, necessitating alternative treatments.
Purpose of the Study:
- To evaluate the safety and efficacy of high-energy transcatheter cardioversion for chronic, poorly tolerated atrial fibrillation.
- To compare transcatheter cardioversion with existing treatments like AV node ablation.
Main Methods:
- 14 patients with chronic AF underwent high-energy transcatheter cardioversion using a His-bundle catheter and specific electrode placement.
- Procedure involved withdrawing the His-bundle catheter until no activity was recorded, then delivering a shock.
Main Results:
- Transcatheter cardioversion successfully restored sinus rhythm in all patients.
- Transient atrioventricular (AV) block occurred in 28% of patients, managed with temporary pacing.
- At one year, 50% of patients maintained sinus rhythm; younger age was linked to recurrence.
Conclusions:
- High-energy transcatheter cardioversion is a safe and effective treatment for chronic, poorly tolerated AF.
- It presents a viable alternative to AV node ablation, mitigating risks of pacemaker implantation and embolism.
- Further research is needed for optimal patient selection and post-procedure drug strategies.
Abstract:
Between August 1991 and May 1993, 14 patients affected by chronic, poorly tolerated atrial fibrillation (AF) were submitted to high energy transcatheter cardioversion. Mean duration of AF was 27.4 +/- 45.1 months. In nine patients (56%), AF lasted for > 1 year. All patients had underlying heart disease, with a mean LVEF of 45.2% +/- 11.8% and a NYHA Class > or = II. Previously, a mean of 2.9 +/- 1.3 patients failed external electrical cardioversion, with and without antiarrhythmics, have been attempted. Transcatheter conversion was performed by pulling the His-bundle catheter back in the right atrial cavity until no His bundle activity was recorded on distal poles, and then delivering the shock between a proximal electrode (cathode) and a back plate (anode). In all patients, transcatheter conversion restored sinus rhythm. Transient complete atrioventricular (AV) block was observed in four patients (28%), and treated by prophylactic temporary pacing. At 1 year, seven patients (50%) were still in sinus rhythm. In this series, only younger age could be related to AF recurrence (46.1 +/- 10.8 vs 63.4 +/- 6.8 years, P < or = 0.004), even if prophylaxis with amiodarone showed a positive trend versus sinus rhythm maintenance (71% vs 14%, P = NS). In conclusion, high energy transcatheter cardioversion is a safe and effective method of restoring sinus rhythm in patients with chronic, poorly tolerated AF. In these patients, high energy transcatheter cardioversion could be considered as an alternative to AV node ablation techniques, avoiding pacemaker implant and embolic risk. Larger studies are needed to determine better patient selection and delineate drug strategy after the procedure.