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[Internal atrial defibrillation after failure of attempted pharmacological and electrical cardioversion. Mid- and
J M Larlet1, J Mansourati, F Verdun
1Département de cardiologie, CHU de la Cavale Blanche, Brest.
Insights
Endocavitary electrical shock cardioversion effectively restored sinus rhythm in 94% of patients with persistent atrial fibrillation. This internal atrial defibrillation shows promise for patients resistant to other treatments.
Area of Science:
- Cardiology
- Electrophysiology
Context:
- Atrial fibrillation (AF) management often involves antiarrhythmic drugs and external electrical cardioversion.
- Persistent AF poses challenges, necessitating alternative therapeutic strategies.
Purpose:
- To evaluate the short- and medium-term efficacy of endocavitary electrical shock for cardioversion in patients with persistent atrial fibrillation.
- To compare the success rates of internal atrial defibrillation with those of external electrical cardioversion.
Summary:
- A study of 36 patients with persistent atrial fibrillation demonstrated a high immediate success rate (94%) for endocavitary electrical shock cardioversion.
- Medium-term follow-up showed sinus rhythm in 57% at 6 months and 33% at 12 months, comparable to external cardioversion efficacy.
- Internal atrial defibrillation is a viable option for patients refractory to conventional cardioversion methods.
Impact:
- These findings support the use of internal atrial defibrillation as a treatment option for difficult-to-treat atrial fibrillation.
- Further research is needed to identify patient profiles that would benefit most from this endocavitary technique as a first-line therapy.
Abstract:
Cardioversion of atrial fibrillation by an endocavitary electrical shock was first proposed during the 1980s. The authors studied the efficacy of this technique at short and medium term in a population of 36 patients (28 men and 8 women) in whom atrial fibrillation persisted despite attempts to reduce it by antiarrhythmic drugs and external electrical cardioversion. The immediate success rate was high : 34 out of 36 patients (94%) and, at medium term, the number with sinus rhythm was comparable to that of studies evaluating the medium-term efficacy of external electrical cardioversion; 19 out of 33 patients (57%) were in sinus rhythm at 6 months and 9 out of 27 patients (33%) at 12 months. These results seem to justify attempts at internal atrial defibrillation in patients in whom the other two techniques of cardioversion have failed. Its use as the method of first intention could be proposed if the profile of "resistant" patients to classical techniques was known, which is unfortunately not presently the case.