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Changes in intracardiac atrial cardioversion threshold at rest and during exercise

M Santini1, C Pandozi, S Toscano

  • 1Department of Heart Disease, San Filippo Neri Hospital, Rome, Italy.

Journal of the American College of Cardiology
|March 1, 1997
PubMed
Summary

Low energy endocavitary cardioversion is safe for chronic atrial fibrillation (AF). Exercise does not affect the atrial defibrillation threshold (ADT), which is higher in chronic AF than reinduced AF.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Low energy endocavitary cardioversion offers an alternative to transthoracic shock for chronic atrial fibrillation (AF).
  • Further evaluation of patient comfort and potential for ventricular arrhythmias is necessary.

Purpose of the Study:

  • To analyze changes in intracardiac atrial defibrillation threshold (ADT) at rest and during exercise in patients with chronic AF.
  • To quantify the risk of low energy endocavitary cardioversion during exertion.
  • To compare ADT in chronic versus reinduced AF.

Main Methods:

  • Sixteen patients with chronic AF underwent two shock sequences to determine ADT at rest and during exercise.
  • Exercise involved isometric contractions of superior limbs; AF was reinduced by atrial pacing.

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  • Patient discomfort was rated on a 1-5 scale post-shock.

    • Main Results:

    • Mean ADT was 6.70 J during exercise and 7.02 J at rest (p=0.59).
    • A significantly lower ADT was observed in the second shock sequence compared to the first (p<0.05).
    • Discomfort scores were similar at rest (3.25) and during exercise (2.94), with no reported complications.

    Conclusions:

    • Low energy endocavitary cardioversion is a safe and effective treatment for chronic AF.
    • Patient discomfort did not typically lead to procedure termination.
    • Exercise does not influence ADT, which is higher in chronic AF than in reinduced AF.