Feasibility and efficacy of electrical cardioversion after cardiac resynchronization implantation in patients with permanent atrial fibrillation.
OBJECTIVE
Patients with permanent atrial fibrillation (AF) who undergo cardiac resynchronization therapy (CRT) may spontaneously recover sinus rhythm during follow-up. We tested the feasibility and efficacy of electrical cardioversion attempted after 3 months of CRT in patients with permanent AF and measured the long-term maintenance of sinus rhythm.


METHODS
Twenty-eight consecutive patients with permanent AF in whom CRT defibrillators had been implanted were scheduled for internal electrical cardioversion after 3 months (group A) and were compared with a control group of 27 patients (group B).


RESULTS
In group A, 22 patients (79 %) were eligible for cardioversion; sinus rhythm was restored in 18 (82 %) of these, with no procedural complications. After 12 months, 16 patients (58 %) in group A were in sinus rhythm, compared with one group B patient who spontaneously recovered sinus rhythm (4 %, p < 0.001). On 12-month evaluation, ejection fraction had improved in both groups, but a reduction in left ventricular end-systolic volume was recorded only in group A patients (p = 0.018 versus baseline).


CONCLUSIONS
In patients with permanent AF, the rhythm control strategy consisting of internal cardioversion, performed by means of the implanted cardioverter-defibrillator after 3 months of CRT, was associated with a high rate of sinus rhythm resumption on long-term follow-up and with a better echocardiographic response to CRT than that seen in patients treated according to a rate control strategy.
Clinica Mediterranea, Naples, Italy. pietro.turco@tin.it
Pietro
P
Turco
Antonio
A
D'Onofrio
Giuseppe
G
Stabile
Francesco
F
Solimene
Vincenzo
V
La Rocca
Filippo
F
Vecchione
Assunta
A
Iuliano
Natale
N
Marrazzo
Stefano
S
De Vivo
Ciro
C
Cavallaro
Valter
V
Bianchi
Alessia
A
Agresta
Carmine
C
Ciardiello
Antonio
A
De Simone
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004554:Electric Countershock / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome