Related Experiment Videos
Prospective randomized trial of external versus internal transcatheter cardioversion in patients with chronic atrial
K E Paravolidakis1, T M Kolettis, G N Theodorakis
12nd Department of Cardiology and General Hospital of Nikea, Athens, Greece. elbee@ath.forth-net.gr
Insights
Internal transcatheter cardioversion acutely restores sinus rhythm more effectively than external cardioversion. However, long-term atrial fibrillation recurrence rates are similar between these treatments.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia requiring effective treatment.
- Conventional external cardioversion has limitations in restoring and maintaining sinus rhythm.
Purpose of the Study:
- To compare the safety and long-term efficacy of internal transcatheter cardioversion versus external cardioversion for chronic, lone atrial fibrillation.
- To assess acute success rates and long-term sinus rhythm maintenance.
Main Methods:
- Forty patients with chronic, lone atrial fibrillation were randomized to internal transcatheter cardioversion or external cardioversion.
- Oral anticoagulation was administered before and after the procedure.
- Patients with unsuccessful procedures could cross over to the alternate method.
Main Results:
- Internal cardioversion acutely restored sinus rhythm in 88% of patients, compared to 40% with external cardioversion (p < 0.01).
- Of those crossed over, 61% were successfully cardioverted to sinus rhythm using internal cardioversion.
- After a mean follow-up of 23 months, 39.3% of patients maintained sinus rhythm; recurrence rates were not statistically different between groups.
Conclusions:
- Internal transcatheter cardioversion demonstrates superior acute efficacy in restoring sinus rhythm compared to external cardioversion.
- Both internal and external cardioversion show comparable long-term efficacy regarding atrial fibrillation recurrence.
- Further research may explore optimal patient selection for each cardioversion method.
Abstract:
To evaluate the safety and long-term efficacy of internal transcatheter cardioversion, forty patients with chronic, lone atrial fibrillation were studied. The patients were randomised to internal transcatheter cardioversion or to conventional external cardioversion. In cases where the procedure was unsuccessful, cross-over to the alternate method was performed. Oral anticoagulation therapy was started three weeks prior to the procedure and was maintained for another three weeks following successful cardioversion. Sinus rhythm was restored in 16/18 patients (88%) in the internal cardioversion group, versus 9/22 patients (40%) in the external cardioversion group (p < 0.01). In addition, 8/13 (61%) patients who were crossed-over to internal cardioversion were successfully cardioverted to sinus rhythm. In contrast, both patients who were crossed-over to external cardioversion remained in atrial fibrillation. During a mean follow-up period of 23 months, 13 (39.3%) patients maintained sinus rhythm. Using the intention to treat principle, the recurrence rate was not statistically different between the two methods. It is concluded that internal cardioversion is more effective in acutely restoring sinus rhythm compared to external cardioversion. However, both methods have similar long-term recurrence rates.