title: Internal cardioversion of chronic atrial fibrillation in patients.
abstract: Transvenous internal cardioversion of chronic AF using a right atrium (RA) coronary sinus (CS) vector requires more energy than cardioversion of paroxysmal AF. Chronic AF is not terminated in 25% of patients using biphasic shocks up to 10 J. We therefore evaluated efficacy, safety, and tolerability of internal cardioversion using a "unipolar" configuration (RA to skin patch) and biphasic shocks in patients with long-lasting AF and different heart disease. In each patient, biphasic R wave synchronous shocks were delivered between a large defibrillating surface area electrode in the RA and a skin patch in the left prepectoral position. Defibrillation protocol started with a test shock of 0.4 J. Shocks were repeated and increased until termination of AF or a maximum of 34 J. Sedation was used when the patient described the shock as painful. This study included 11 patients with a mean age of 67 +/- 8 years (range 56-83). AF duration was > or = 1 month in all patients with a mean duration of 11 +/- 11 months (range 2-36). Underlying heart disease was present in all patients and the mean left atrial dimension was 43 +/- 9 mm (range 26-57). AF was terminated in 10 of 11 patients (91%) with a mean delivered energy of the successful shocks of 18.7 +/- 8.7 J (median energy 16.9 J; range 7.3-32.5) and a mean leading edge voltage of 564 +/- 129 V. The mean shock impedance at the defibrillation threshold was 71 +/- 13 omega (range 59-103). A total of 131 shocks were delivered without any complication and proarrhythmia episodes. We conclude that low energy "unipolar" internal cardioversion is a simple, safe, and effective technique for termination of chronic AF in patients with heart disease. The procedure is often tolerated under light sedation.
authors.affiliation: Division of Cardiology, Hospital G.B. Grassi, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Neri
authors.forename: P
authors.initials: P
authors.lastname: Palermo
authors.forename: A S
authors.initials: AS
authors.lastname: Cesario
authors.forename: D
authors.initials: D
authors.lastname: Baragli
authors.forename: E
authors.initials: E
authors.lastname: Amici
authors.forename: G
authors.initials: G
authors.lastname: Gambelli
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D002908:Chronic Disease; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D000074:Acenocoumarol; D000638:Amiodarone