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Low energy internal atrial cardioversion in atrial fibrillation lasting more than a year
G Boriani1, M Biffi, F Pergolini
1Institute of Cardiology, University of Bologna, Italy. cardio1@almadns.unibo.it
Insights
Low energy internal atrial cardioversion effectively restores sinus rhythm (SR) in patients with chronic atrial fibrillation (AF) lasting over a year. Long-term results are satisfactory, though antiarrhythmic drugs are often needed post-procedure.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Chronic atrial fibrillation (AF) persisting over one year presents treatment challenges.
- Restoring sinus rhythm (SR) is a primary goal in managing chronic AF.
Purpose of the Study:
- To evaluate the efficacy of low-energy internal atrial cardioversion for chronic AF.
- To assess the success rate and recurrence of SR in patients with long-standing AF.
Main Methods:
- Fifteen patients with chronic AF (>1 year) underwent R-wave synchronized biphasic shocks.
- Shocks were delivered using internal atrial electrodes with minimal or no anesthesia.
- Antiarrhythmic medications (flecainide, sotalol, amiodarone) were administered post-procedure.
Main Results:
- Stable SR was achieved in 93% (14/15) of patients.
- The procedure used low mean delivered energy (7.3 J).
- AF recurred in 36% (5/15) of patients during follow-up, with most recurrences within 3 days.
Conclusions:
- Low-energy internal atrial cardioversion is highly effective for chronic AF (>1 year).
- Satisfactory long-term freedom from AF is achievable with appropriate antiarrhythmic management.
- Proactive antiarrhythmic treatment is crucial, especially in the initial days post-conversion.
Unlabelled:
The aim of this study was to evaluate the efficacy of low energy internal atrial cardioversion in restoring sinus rhythm (SR) in patients with chronic atrial fibrillation (AF) persisting > 1 year. Fifteen patients with chronic AF lasting > 1 year (from 13-48 months, mean 24 +/- 13 months) were studied. R wave synchronized 3/3 ms biphasic shocks were delivered between right atrial and coronary sinus (left pulmonary artery in five patients) electrodes. Sedatives or anesthetics were administered only at the patient's request.
Results:
Stable SR was restored in 14 (93%) of 15 patients after shocks with a mean leading edge voltage of 377 +/- 77 V (range 260-500) and a mean delivered energy of 7.3 +/- 3.4 J (range 2.6-12.9). The procedure was performed without anesthesia in 6 (40%) patients. All successfully cardioverted patients were treated with flecainide, sotalol, or amiodarone. During a follow up of 7.7 +/- 7.9 months (range 1-24) AF recurred in five (36%) patients. Three of five AF recurrences occurred within 3 days after conversion to SR.
Conclusion:
Internal low energy atrial cardioversion is highly effective in restoring SR even in patients with AF lasting > 1 year. The long-term results from the standpoint of freedom from AF recurrences, are satisfactory, although additional antiarrhythmic treatment is required, particularly in the first days after conversion.