title: Successful external cardioversion of atrial fibrillation in patients referred to an electrophysiologist for internal cardioversion.
abstract: BACKGROUND
  Internal cardioversion of atrial fibrillation with direct current energy has become an increasingly employed technique for patients who fail external cardioversion.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether internal cardioversion could be avoided by careful attention to cardioversion technique in a group of patients referred specifically for internal cardioversion after failed external cardioversion by community cardiologists.
  
  
  METHODS
  We performed external cardioversion utilizing two operators applying significant pressure to the thorax with up to 360 J prior to the planned internal cardioversion in 20 patients referred for internal cardioversion after failed attempts at external cardioversion.
  
  
  RESULTS
  Sixteen patients (80%) were successfully cardioverted and avoided the risk, inconvenience, and cost of internal cardioversion.
  
  
  CONCLUSIONS
  External cardioversion with significant anterior paddle pressure by two operators can decrease the need for internal cardioversion in a significant portion of patients referred to electrophysiologists for internal cardioversion and should be considered prior to an invasive procedure.
authors.affiliation: Department of Medicine, University of Chicago, Illinois, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Verdino
authors.forename: J J
authors.initials: JJ
authors.lastname: Teuteberg
authors.forename: M C
authors.initials: MC
authors.lastname: Burke
authors.forename: D E
authors.initials: DE
authors.lastname: Kopp
authors.forename: C T
authors.initials: CT
authors.lastname: Johnson
authors.forename: A C
authors.initials: AC
authors.lastname: Lin
authors.forename: M
authors.initials: M
authors.lastname: Alberts
authors.forename: J G
authors.initials: JG
authors.lastname: Kall
authors.forename: D J
authors.initials: DJ
authors.lastname: Wilber
mesh_terms: D001281:Atrial Fibrillation / Q000628:therapy*; D015331:Cohort Studies; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D017211:Treatment Failure