title: Internal low energy cardioversion of atrial fibrillation using a single lead system: comparison of a left and right pulmonary artery catheter approach.
abstract: Internal cardioversion (ICV) has been demonstrated as an effective and safe method for restoring sinus rhythm in patients with AF. Recently, a new single lead system with a balloon-guided cardioversion catheter was introduced. ICV was performed after advancing a 7.5 Fr catheter flow-directed into the left or right pulmonary artery (PA, distal array, cathode). The proximal array (anode) was placed at the lateral RA wall. Synchronized shocks (3/3 ms biphasic impulse) were applied using a stepwise protocol (0.5, 3, 6, 9, 12, 15 J) until sinus rhythm was restored or maximum energy (15 J) was reached. Sixty-five patients (mean age 58 +/- 13 years) with acute and chronic AF were included. Sinus rhythm could be restored in 59 (91%) patients. Cardioversion success was 93% in the left PA compared to 86% in right PA. DFTs for the left and right PA approaches were 7.1 +/- 4.0 J and 10.2 +/- 4.0 J, respectively (P < 0.0001). It was significantly higher in patients with an AF history > 7 days (7.2 +/- 4.1 J) than for those with a recent onset of AF (5.6 +/- 4.1 J), P = 0.0012. Shock impedance differed for the left and right PA lead configuration (53 +/- 11 vs 49 +/- 13 omega, P < 0.05). A right PA lead configuration is as effective compared to a left PA catheter approach when performing ICV for AF. ICV with a single lead system is safe and cardioversion success is comparable to other internal and external cardioversion techniques. In combination with hemodynamic monitoring, flow-directed nonfluoroscopic catheter positioning is feasible and may serve as a valuable therapeutic and diagnostic tool in intensive care units.
authors.affiliation: Deutsches Herzzentrum und 1. Medizinische Klinik der Technischen Universität, München, Germany. schmieder@dhm.mhn.de
authors.forename: S
authors.initials: S
authors.lastname: Schmieder
authors.forename: M A
authors.initials: MA
authors.lastname: Schneider
authors.forename: M R
authors.initials: MR
authors.lastname: Karch
authors.forename: C
authors.initials: C
authors.lastname: Schmitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D004554:Electric Countershock / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery