Intracardiac low-energy versus transthoracic high-energy direct-current cardioversion of atrial fibrillation: a randomised comparison.
Of 54 patients with long-standing atrial fibrillation (mean duration 8.3 months), 27 patients were randomised to transvenous low-energy intracardiac biphasic direct-current (DC) cardioversion (ICV) using a single-lead balloon-tipped catheter, and 27 patents were randomised to conventional high-energy transthoracic monophasic DC cardioversion (TCV). ICV was performed with increasing energy levels (7.5-10-12.5-15 J) during mild sedation. TCV was performed with 200-360-360 J during general anaesthesia. Cardioversion to sinus rhythm occurred in 93% (25/27) following ICV and in 67% (18/27) following TCV (p = 0.04). Due to the higher cardioversion rate following ICV, more patients were in sinus rhythm during 180 days of follow-up (log rank test, p = 0.04). Low-energy intracardiac cardioversion represents a highly efficacious alternative to high-energy transthoracic cardioversion.
Friberg
Jens
J
Department of Cardiovascular Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. jensfriberg@dadlnet.dk
Gadsbøll
Niels
N
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D004554:Electric Countershock / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011405:Propafenone / Q000627:therapeutic use; D011897:Random Allocation; D012008:Recurrence; D012720:Severity of Illness Index; D013015:Sotalol / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D020107:Troponin T; D011405:Propafenone; D013015:Sotalol; D003402:Creatine Kinase; D000638:Amiodarone