Advertisement

How Effective and Safe Is Internal Direct Current Shock for Atrial Fibrillation Refractory to External Cardioversion?

  • M. Santini
  • C. Pandozi
  • S. Toscano
  • G. Altamura
  • A. Castro
  • S. Tonioni
  • B. Magris
Conference paper

Abstract

In a group of patients (6%–50% in different series) with atrial fibrillation (AF) external cardioversion and pharmacological therapy failed to restore sinus rhythm. AF is not a benign arrhythmia; it causes disabling symptoms and hemodynamic disturbances related to the rapid ventricular response and/or to the loss of the atrial kick. Moreover, patients with AF are at a higher risk of systemic embolism and stroke as assessed by the Framingham study (1, 2). In patients with AF resistant to pharmacologie and transthoracic electrical cardioversion the following therapeutic options are available:
  • Drugs acting on the atrioventricular (AV) node conduction (verapamil, beta-blocking agents)

  • AV node or His bundle ablation with subsequent pacemaker insertion

  • High energy internal cardioversion (HEIC)

  • Low energy internal cardioversion (LEIC)

Keywords

Atrial Fibrillation Sinus Rhythm Atrial Fibrillation Recurrence Chronic Atrial Fibrillation Atrial Size 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wolf PA, Dawber TR, Thomas HE Jr (1978) Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 28: 973–977PubMedGoogle Scholar
  2. 2.
    Wolf PA, Abbott RD, Kannel WB (1987) Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham study. Arch Intern Med 147: 1561–1564PubMedCrossRefGoogle Scholar
  3. 3.
    Levy S, Lacombe P, Cointe R, Bru P (1988) High energy trans-catheter cardioversion of chronic atrial fibrillation. J Am Coll Cardiol 12: 514–518PubMedCrossRefGoogle Scholar
  4. 4.
    Hinton RC, Kistler P, Fallon JR, Friedlich AL, Fisher CM (1977) Influence of etiology of atrial fibrillation on incidence of systemic embolism. Am J Cardiol 40: 509–513PubMedCrossRefGoogle Scholar
  5. 5.
    Aberg H (1969) Atrial fibrillation: a study of atrial thrombosis and sistemic embolism in a necropsy material. Acta Med Scand 185: 373–379PubMedCrossRefGoogle Scholar
  6. 6.
    Jackman WM, Xunzhang W, Friday KJ, Fitzgerald DM; Roman C et al (1991) Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Circulation 83: 1562–1576PubMedGoogle Scholar
  7. 7.
    Yeung-Lai-Wah AJ, Alison JF, Lonergan L, Mohama R, Leather R, Kerr CR (1991) High success rate of atrioventricular node ablation with radiofrequency energy. J Am Coll Cardiol 18: 1753–1758PubMedCrossRefGoogle Scholar
  8. 8.
    Levy S, Dolla E, Ebagosti A, Bru P (1990) Internal cardioversion for chronic atrial fibrillation. In: Touboul P, Waldo AL (eds) Atrial arrythmias. Mosby, St. Louis, pp 411–418Google Scholar
  9. 9.
    Kumagay K, Yamanouchi Y, Tadayuki H, Arakawa K (1991) Effects of transcatheter cardioversion on chronic lone atrial fibrillation. PACE 14: 1571–1575CrossRefGoogle Scholar
  10. 10.
    Levy S, Philippe Lauribe, Dolla E, Kou W, Kadish A, Kalkins H et al (1992) A randomized comparison of external and internal cardioversion of chronic atrial fibrillation. Circulation 86: 1415–1420PubMedGoogle Scholar
  11. 11.
    Alt E, Schmitt C, Ammer R et al (1994) Initial experience with intracardiac atrial defibrillation in patients with chronic atrial fibrillation. PACE 17: 1067–1078PubMedCrossRefGoogle Scholar
  12. 12.
    Baker B M, Botteron GW, Smith JM (1995) Low-energy internal cardioversion for atrial fibrillation resistant to external cardioversion. J Cardiovasc Electrophysiol 6: 44–47PubMedCrossRefGoogle Scholar
  13. 13.
    Hoyt R, Grayzel J, Kerber RE (1981) Determinants of intra-cardiac current in defibrillation: experimental studies in dogs. Circulation 64: 818–823PubMedCrossRefGoogle Scholar
  14. 14.
    Geddes LA, Tacker WA, Rosborough JP, Moore AG, Cabler PS (1974) Electrical dose for ventricular defibrillation of large and small animals using precordial electrodes. J Clin Invest 53: 310–319PubMedCrossRefGoogle Scholar
  15. 15.
    Connell PN, Ewy GA, Dahl CF, Ewy MD (1973) Transthoracic impedance to defibrillator discharge: effect of electrode size and chest wall interface. J Electrocardiogr 6: 313–317CrossRefGoogle Scholar
  16. 16.
    Ewy GA (1980) Direct current shock and trancardiac impedance. Am J Cardiol 45: 909–913PubMedCrossRefGoogle Scholar
  17. 17.
    Flugelman MY, Hasin Y, Katznelson N (1984) Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosis. Am J Cardiol 54: 617–619PubMedCrossRefGoogle Scholar
  18. 18.
    Henry WL, Morganroth J, Pearlman AS (1976) Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53: 273–279PubMedGoogle Scholar
  19. 19.
    Ewy G, Ulfers L, Hager WD (1980) Response of atrial fibrillation to therapy: role of etiology and left atrial diameter. J Electrocardiol 13: 119–124PubMedCrossRefGoogle Scholar
  20. 20.
    Waris E, Kreus KE, Salokannel J (1971) Factors influencing persistence of sinus rhythm after DC shock treatment of atrial fibrillation. Acta Med Scand 189: 161–166PubMedCrossRefGoogle Scholar
  21. 21.
    Mancini GBJ, Goldberger LA (1982) Cardioversion of atrial fibrillation: considerations of embolization, anticoagulation, prophylactic pacemaker, and long-term success. Am Heart J 104: 617–621PubMedCrossRefGoogle Scholar
  22. 22.
    Dittrich HC, Erickson JS, Schneiderman T, Blacky R, Savides T, Nicod PH (1989) Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 63: 193–197PubMedCrossRefGoogle Scholar
  23. 23.
    Cooper R, Alferness C, Smith W et al (1993) Internal cardioversion of atrial defibrillation in sheep. Circulation 87: 1673–1686PubMedGoogle Scholar
  24. 24.
    Powell AC, Garan H, McGovern BA et al (1992) Low energy conversion of atrial fibrillation in the sheep. J Am Coll Cardiol 20: 707–711PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • M. Santini
    • 1
  • C. Pandozi
    • 1
  • S. Toscano
    • 1
  • G. Altamura
    • 1
  • A. Castro
    • 1
  • S. Tonioni
    • 1
  • B. Magris
    • 1
  1. 1.Dipartimento delle Malattie del CuoreOspedale S Filippo NeriRomeItaly

Personalised recommendations