title: Incidence and management of early recurrent atrial fibrillation (ERAF) after transthoracic electrical cardioversion.
abstract: OBJECTIVE
  The purpose was to determine the incidence of early recurrent atrial fibrillation (ERAF) after transthoracic cardioversion (CV) of persistent atrial fibrillation (AF) and to evaluate the efficacy of a predefined strategy for its management.
  
  
  RESULTS
  Consecutive patients (n=135) underwent elective CV of AF. CV was performed according to a predefined step-up protocol with rising energy delivery (200 J to 360 J). ERAF was defined as a relapse of AF within 1 min after at least two sinus beats. For proper identification of success of CV, additional endocardial recordings were obtained by an electrode catheter positioned in the high right atrium. In case of ERAF, further CVs were attempted, first with higher energy delivery only, second after intravenous flecainide. If transthoracic CV was ineffective, an internal CV was scheduled. All patients could be converted into sinus rhythm. Sixteen patients (12%) had ERAF. ERAF could be suppressed by further shock delivery in 31% of them. In the remaining 69%, a combination of i.v. flecainide and repeated CV was effective in controlling ERAF. Clinical and echocardiographic parameters were comparable in patients with or without ERAF.
  
  
  CONCLUSIONS
  (1) In the patient population studied, transthoracic CV of AF was technically highly efficacious, so that an internal CV was not necessary in any of the cases. (2) Clinical success of transthoracic cardioversion was limited by ERAF in 12% of the patients. (3) Using the described protocol, ERAF could be suppressed in all patients.
authors.affiliation: Medizinische Universitäts- und Poliklinik, Innere Medizin III, Kardiologie/Angiologie, Universitätskliniken des Saarlandes, D-66421 Homburg, Germany. siaplaouras@aol.com
authors.forename: Stephanos
authors.initials: S
authors.lastname: Siaplaouras
authors.forename: Jens
authors.initials: J
authors.lastname: Jung
authors.forename: Axel
authors.initials: A
authors.lastname: Buob
authors.forename: Armin
authors.initials: A
authors.lastname: Heisel
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D005424:Flecainide / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D005424:Flecainide