Efficacy and safety of transvenous atrial cardioversion in patients with mitral valve disease and long-standing atrial fibrillation.
BACKGROUND
Transvenous internal cardioversion (ICV) of atrial fibrillation (AF) may be successful after unsuccessful external CV. However, the safety and efficacy of ICV in patients with significant mitral valve disease and AF of long duration have not been evaluated prospectively.


METHODS
This study included 22 consecutive patients (mean age = 59 +/- 14 years, 12 women) with mitral regurgitation grade = II (n = 14) or after mitral valve replacement (n = 8), who underwent ICV with 3/3 ms biphasic shocks delivered via two defibrillation catheters placed in the right atrium and the coronary sinus, respectively. The mean left atrial diameter was 53 +/- 7 mm (range 45-68), and AF had been diagnosed for a median of 24 months. All patients received oral amiodarone pretreatment followed by a maintenance dose of 200 mg/day.


RESULTS
Sinus rhythm (SR) was restored by ICV in 15/20 patients (75%), and returned spontaneously in two patients during amiodarone pretreatment. The mean threshold for ICV was 6.2 +/- 3.5 J. Sinus node disease was present in one patient after ICV, and two patients developed amiodarone-induced hyperthyroidism. During a follow-up of 11 +/- 5 months, 8 patients had recurrent AF. The remaining 11 patients who were successfully cardioverted remained in stable SR.


CONCLUSIONS
SR can be safely and successfully restored by ICV in patients with MVD and long-standing AF. During intermediate-term follow-up, a significant proportion of patients remained in SR with oral amiodarone therapy.
Grönefeld
G C
GC
Department of Medicine, Division of Cardiology, J.W. Goethe-University, Frankfurt, Germany.
Li
Y G
YG
Bogun
F
F
Hohnloser
S H
SH
D000284:Administration, Oral; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization; D002908:Chronic Disease; D003402:Creatine Kinase / Q000097:blood; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000097:blood / Q000150:complications*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000097:blood / Q000150:complications; D011446:Prospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D000889:Anti-Arrhythmia Agents; D020107:Troponin T; D003402:Creatine Kinase; D000638:Amiodarone