title: Disappointing Success of Electrical Cardioversion for New-Onset Atrial Fibrillation in Cardiosurgical ICU Patients.
abstract: OBJECTIVE
  To assess the success of electrical cardioversion for the treatment of new-onset atrial fibrillation in critically ill patients and to evaluate the stability of sinus rhythm in responders during the subsequent 24 hours.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Twelve-bed cardiosurgical ICU at a university hospital.
  
  
  METHODS
  Seventy-two consecutive patients with postoperative new-onset atrial fibrillation (<7 d of duration) treated by electrical cardioversion.
  
  
  METHODS
  Electrical cardioversion using synchronized biphasic shocks.
  
  
  RESULTS
  During 144 electrical cardioversions, 209 shocks were delivered to 72 patients. Maximal energy (200 J) was used in 85% of shocks. Electrical cardioversion immediately restored sinus rhythm in 102 sessions (71%). Pretreatment with amiodarone did not increase the success rates. During the follow-up, the percentages of sinus rhythm decreased from 43% after 1 hour to 23% after 24 hours. However, at ICU discharge, 54 patients (75%) were in sinus rhythm. Of the 54 patients in sinus rhythm, only 18 (33%) converted to sinus rhythm after repeated cardioversions, whereas the remaining 36 (66%) did so spontaneously or with amiodarone.
  
  
  CONCLUSIONS
  Biphasic electrical cardioversion in cardiosurgical ICU patients was immediately successful in restoring sinus rhythm in 71% of sessions. However, early relapse of atrial fibrillation was common in the 24-hour follow-up. At ICU discharge, the majority of patients were in sinus rhythm, but the efficacy of repetitive electrical cardioversion in restoring sinus rhythm was disappointing.
authors.affiliation: 1Cardiosurgical Intensive Care Unit, Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. 2Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. 3Epidemiology, Biostatistics and Prevention Institute (EBPI), Department of Biostatistics, University of Zurich, Zurich, Switzerland.
authors.forename: Mattia
authors.initials: M
authors.lastname: Arrigo
authors.forename: Natalie
authors.initials: N
authors.lastname: Jaeger
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.forename: Alain
authors.initials: A
authors.lastname: Rudiger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004554:Electric Countershock / Q000379:methods / Q000401:mortality*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013557:Switzerland; D016896:Treatment Outcome