title: Effectiveness of direct-current cardioversion for treatment of supraventricular tachyarrhythmias, in particular atrial fibrillation, in surgical intensive care patients.
abstract: OBJECTIVE
  To evaluate primary success rate and effectiveness of direct-current cardioversion in postoperative critically ill patients with new-onset supraventricular tachyarrhythmias.
  
  
  METHODS
  Prospective intervention study.
  
  
  METHODS
  Twelve-bed surgical intensive care unit in a university teaching hospital.
  
  
  METHODS
  Thirty-seven consecutive, adult surgical intensive care unit patients with new-onset supraventricular tachyarrhythmias without previous history of tachyarrhythmias.
  
  
  METHODS
  Direct-current cardioversion using a monophasic, damped sinus-wave defibrillator. Energy levels used were 50, 100, 200, and 300 J for regular supraventricular tachyarrhythmias (n = 6) and 100, 200, and 360 J for irregular supraventricular tachyarrhythmias (n = 31).
  
  
  RESULTS
  None of the patients was hypoxic, hypokalemic, or hypomagnesemic at onset of supraventricular tachyarrhythmia. Direct-current cardioversion restored sinus rhythm in 13 of 37 patients (35% primary responders). Most patients responded to the first or second direct-current cardioversion shock. Only one of 25 patients requiring more than two direct-current cardioversion shocks converted into sinus rhythm. Primary responders were significantly younger and demonstrated significant differences in arterial Po2 values at onset of supraventricular tachyarrhythmias compared with nonresponders. At 24 and 48 hrs, only six (16%) and five (13.5%) patients remained in sinus rhythm, respectively.
  
  
  CONCLUSIONS
  In contrast to recent literature, direct-current cardioversion proved to be an ineffective method for treatment of new-onset supraventricular tachyarrhythmias and, in particular, atrial fibrillation with a rapid ventricular response in surgical intensive care unit patients.
authors.affiliation: Department of Anesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mayr
authors.forename: Nicole
authors.initials: N
authors.lastname: Ritsch
authors.forename: Hans
authors.initials: H
authors.lastname: Knotzer
authors.forename: Martin
authors.initials: M
authors.lastname: Dünser
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schobersberger
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Norbert
authors.initials: N
authors.lastname: Mutz
authors.forename: Walter
authors.initials: W
authors.lastname: Hasibeder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy*; D003422:Critical Care; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013617:Tachycardia, Supraventricular / Q000628:therapy*