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Low energy intracardiac cardioversion after failed conventional external cardioversion of atrial fibrillation
11. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Germany.
Insights
Intracardiac cardioversion is a safe and effective treatment for chronic atrial fibrillation when external cardioversion fails. This method offers a new option for restoring normal heart rhythm in difficult cases.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Atrial fibrillation is a common arrhythmia.
- External cardioversion is a standard treatment but can be unsuccessful.
- Intracardiac cardioversion is a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy of intracardiac cardioversion.
- To assess its safety in patients with chronic atrial fibrillation.
- To identify patient characteristics that benefit most from this procedure.
Main Methods:
- Prospective study of 25 patients with chronic atrial fibrillation.
- Patients had failed at least three external cardioversion attempts.
- Intracardiac shocks delivered via electrodes in the right atrium and coronary sinus or pulmonary artery.
Main Results:
- Successful conversion in 22 of 25 patients (88%) at low energy levels.
- Mean defibrillation threshold was 6.5 +/- 3.0 J.
- No severe complications observed; 55% maintained sinus rhythm at 15-month follow-up.
Conclusions:
- Intracardiac cardioversion is a viable option for patients with failed external cardioversion.
- It is an effective and safe method for restoring sinus rhythm.
- The procedure can be performed with minimal sedation.
Objectives:
This study was designed to evaluate the efficacy of intracardiac cardioversion in patients with chronic atrial fibrillation after unsuccessful external cardioversion.
Background:
Previous studies in patients with atrial fibrillation undergoing intracardiac cardioversion have suggested that intracardiac cardioversion is highly effective and safe. However, the characteristics of patients who benefit most from this invasive technique are unknown.
Methods:
We prospectively studied 25 consecutive patients with chronic atrial fibrillation (11 +/- 9 months). All patients had undergone at least three attempts at conventional external transthoracic cardioversion by means of paddles in an anteroposterolateral position applying energies up to 360 J without success. Intracardiac shocks were delivered by an external defibrillator through defibrillation electrodes placed in the right atrium and coronary sinus or in the right atrium and left pulmonary artery. After conversion, all patients were treated orally with sotalol (mean 194 +/- 63 mg/day).
Results:
Internal cardioversion was successful in 22 of 25 patients at a mean defibrillation threshold of 6.5 +/- 3.0 J. Mean lead impedance was 56.4 +/- 7.4 omega. No severe complications were observed. At a mean follow-up of 15 +/- 12 months, 12 (55%) of the patients treated successfully remained in sinus rhythm.
Conclusions:
In patients with failed external cardioversion, internal cardioversion offers a new option for restoring sinus rhythm. Intracardiac cardioversion is an effective and safe method and can be easily performed in patients with minimal sedation.