title: Treatment satisfaction of internal versus external cardioversion in patients with chronic atrial fibrillation--a randomized, prospective, 28-day follow-up study.
abstract: OBJECTIVE
  The use of internal cardioversion (IC) in chronic atrial fibrillation (AF) may be limited by procedure-related distress. This procedure may be efficacious but is not necessarily perceived as satisfactory by the patient because of the frequent procedure-related distress.
  
  
  METHODS
  We compared treatment satisfaction in 55 patients with chronic AF referred for cardioversion (CV). Satisfaction with conventional external cardioversion (EC, n = 27) and low-energy IC (n = 28) was compared immediately after the approach and at 28-day follow-up.
  
  
  RESULTS
  Four hours after CV, satisfaction scores (ranging from 0 to 7) were higher with EC (mean 6.1 standard deviation [SD] +/- 1.4) versus IC (m = 5.4 SD +/- 1.8) (p = 0.09). At 28 days, treatment satisfaction decreased in EC (m = 5.5 SD +/- 2.1) and increased in the IC group (5.7 SD +/- 1.8) because of a decrease in the trustful attitude subscale (p = 0.026) followed by tolerance for distressing factors (p = 0.059). The analysis of variance for repeated measures revealed a significant time by method interaction effect (p = 0.04). Patients prone to developing low treatment satisfaction (LTS) at follow-up were more anxious (p = 0.007) before treatment. They suffered more from sleeping disorders (p = 0.009) and considered their disease condition to be worse than that in their counterparts (p = 0.027). Low treatment satisfaction at 28 days was associated with anxiety (p = 0.017), depression (p = 0.01), and the perception of heart-related symptoms (p = 0.001). Multivariate analysis revealed the failure to maintain sinus rhythm (p = 0.001) as the most powerful contributor to LTS.
  
  
  CONCLUSIONS
  The novel IC approach causes acute procedure-related distress but has no enduring negative psychological side effects. Despite a greater patient perception of distressing procedure-related factors during IC compared with EC, the IC approach provides a greater 28-day benefit in terms of tolerability and acceptance on the part of the patients. Failure to maintain sinus rhythm rather than the method applied contributes most to LTS.
authors.affiliation: Institut und Poliklinik für Psychosomatische Medizin, Med. Psychologie und Psychotherapie des Klinikums rechts der Isar der Technischen Universität, Munich, Germany. kh.ladwig@lrz.tu-muenchen.de
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
authors.forename: Günter
authors.initials: G
authors.lastname: Lehmann
authors.forename: Birgitt
authors.initials: B
authors.lastname: Marten-Mittag
authors.forename: Heidi
authors.initials: H
authors.lastname: Simon
authors.forename: Eckhard
authors.initials: E
authors.lastname: Alt
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000523:psychology; D001281:Atrial Fibrillation / Q000523:psychology / Q000628:therapy*; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D003863:Depression / Q000523:psychology; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology; D013997:Time Factors