title: Low energy internal cardioversion of atrial fibrillation resistant to transthoracic shocks.
abstract: OBJECTIVE
  To investigate the efficacy of internal cardioversion using low energy shocks delivered with a biatrial electrode configuration in chronic atrial fibrillation resistant to transthoracic shocks.
  
  
  METHODS
  Low energy internal cardioversion was attempted in 11 patients who had been in atrial fibrillation for 233 (SD 193) days and had failed to cardiovert with transthoracic shocks of 360 J in both apex-base and anterior-posterior positions. Synchronised biphasic shocks of up to 400 V (approximately 6 J) were delivered, usually with intravenous sedation only, between high surface area electrodes in the right atrium and the left atrium (coronary sinus in nine, left pulmonary artery in one, left atrium via patent foramen ovale in one).
  
  
  RESULTS
  Sinus rhythm was restored in 8/11 patients. The mean leading edge voltage of successful shocks was 363 (46) V [4.9 (1.2) J]. Higher energy shocks induced transient bradycardia [time to first R wave 1955 (218) ms]. No proarrhythmia or other acute complications were observed.
  
  
  CONCLUSIONS
  Low energy internal cardioversion of atrial fibrillation can restore sinus rhythm in patients in whom conventional transthoracic shocks have failed.
authors.affiliation: St George's Hospital, London.
authors.forename: S M
authors.initials: SM
authors.lastname: Sopher
authors.forename: F D
authors.initials: FD
authors.lastname: Murgatroyd
authors.forename: A K
authors.initials: AK
authors.lastname: Slade
authors.forename: I
authors.initials: I
authors.lastname: Blankoff
authors.forename: E
authors.initials: E
authors.lastname: Rowland
authors.forename: D E
authors.initials: DE
authors.lastname: Ward
authors.forename: A J
authors.initials: AJ
authors.lastname: Camm
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000628:therapy*; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged