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. 1999;26(2):114–119.

Low-energy internal cardioversion of atrial fibrillation after failed external cardioversion: Texas Heart Institute experience and review of the literature.

M Zaqqa 1, H Afshar 1, G R Khoshnevis 1, J A Lopez 1, A Massumi 1
PMCID: PMC325614  PMID: 10397433

Abstract

In patients with atrial fibrillation, low-energy internal cardioversion may be used to restore sinus rhythm after external cardioversion fails. We used this method in 8 consecutive patients with a mean age of 69.5+/-8.3 (SD) years, 7 (87.5%) of whom were successfully treated with a mean 9.1 J (range, 4 to 14 J). No patient had ventricular arrhythmias at the time of cardioversion, or local groin complications afterward. One patient had recurrent atrial fibrillation the morning after cardioversion, and another patient had an embolus to the renal artery 20 days posttreatment. After 1 month, 5 patients were still in sinus rhythm, and 1 patient was lost to follow-up. This study confirms the efficacy of internal cardioversion in this setting and stresses the importance of a standard anticoagulation protocol before and after cardioversion.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alt E., Ammer R., Schmitt C., Evans F., Lehmann G., Pasquantonio J., Schömig A. A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion. Eur Heart J. 1997 Nov;18(11):1796–1804. doi: 10.1093/oxfordjournals.eurheartj.a015175. [DOI] [PubMed] [Google Scholar]
  2. Alt E., Schmitt C., Ammer R., Coenen M., Fotuhi P., Karch M., Blasini R. Initial experience with intracardiac atrial defibrillation in patients with chronic atrial fibrillation. Pacing Clin Electrophysiol. 1994 May;17(5 Pt 2):1067–1078. doi: 10.1111/j.1540-8159.1994.tb01462.x. [DOI] [PubMed] [Google Scholar]
  3. Alt E., Schmitt C., Ammer R., Plewan A., Evans F., Pasquantonio J., Ideker T., Lehmann G., Pütter K., Schömig A. Effect of electrode position on outcome of low-energy intracardiac cardioversion of atrial fibrillation. Am J Cardiol. 1997 Mar 1;79(5):621–625. doi: 10.1016/s0002-9149(96)00827-2. [DOI] [PubMed] [Google Scholar]
  4. Ammer R., Alt E., Ayers G., Lehmann G., Schmitt C., Pasquantonio J., Pütter K., Schmidt M., Schömig A. Pain threshold for low energy intracardiac cardioversion of atrial fibrillation with low or no sedation. Pacing Clin Electrophysiol. 1997 Jan;20(1 Pt 2):230–236. doi: 10.1111/j.1540-8159.1997.tb04849.x. [DOI] [PubMed] [Google Scholar]
  5. Baker B. M., Botteron G. W., Smith J. M. Low-energy internal cardioversion for atrial fibrillation resistant to external cardioversion. J Cardiovasc Electrophysiol. 1995 Jan;6(1):44–47. doi: 10.1111/j.1540-8167.1995.tb00756.x. [DOI] [PubMed] [Google Scholar]
  6. Cooper R. A., Alferness C. A., Smith W. M., Ideker R. E. Internal cardioversion of atrial fibrillation in sheep. Circulation. 1993 May;87(5):1673–1686. doi: 10.1161/01.cir.87.5.1673. [DOI] [PubMed] [Google Scholar]
  7. Jung J., Heisel A., Fries R., Köllner V. Tolerability of internal low-energy shock strengths currently needed for endocardial atrial cardioversion. Am J Cardiol. 1997 Dec 1;80(11):1489–1490. doi: 10.1016/s0002-9149(97)00733-9. [DOI] [PubMed] [Google Scholar]
  8. Kinch J. W., Davidoff R. Prevention of embolic events after cardioversion of atrial fibrillation. Current and evolving strategies. Arch Intern Med. 1995 Jul 10;155(13):1353–1360. [PubMed] [Google Scholar]
  9. Kumagai K., Yamanouchi Y., Tashiro N., Hiroki T., Arakawa K. Low energy synchronous transcatheter cardioversion of atrial flutter/fibrillation in the dog. J Am Coll Cardiol. 1990 Aug;16(2):497–501. doi: 10.1016/0735-1097(90)90610-2. [DOI] [PubMed] [Google Scholar]
  10. LOWN B., PERLROTH M. G., KAIDBEY S., ABE T., HARKEN D. E. "Cardioversion" of atrial fibrillation. A report on the treatment of 65 episodes in 50 patients. N Engl J Med. 1963 Aug 15;269:325–331. doi: 10.1056/NEJM196308152690701. [DOI] [PubMed] [Google Scholar]
  11. Lok N. S., Lau C. P., Ho D. S., Tang Y. W. Hemodynamic effects and clinical determinants of defibrillation threshold for transvenous atrial defibrillation using biatrial biphasic shocks in patients with chronic atrial fibrillation. Pacing Clin Electrophysiol. 1997 Apr;20(4 Pt 1):899–908. doi: 10.1111/j.1540-8159.1997.tb05492.x. [DOI] [PubMed] [Google Scholar]
  12. Lok N. S., Lau C. P., Tse H. F., Ayers G. M. Clinical shock tolerability and effect of different right atrial electrode locations on efficacy of low energy human transvenous atrial defibrillation using an implantable lead system. J Am Coll Cardiol. 1997 Nov 1;30(5):1324–1330. doi: 10.1016/s0735-1097(97)00298-2. [DOI] [PubMed] [Google Scholar]
  13. Lévy S., Ricard P., Gueunoun M., Yapo F., Trigano J., Mansouri C., Paganelli F. Low-energy cardioversion of spontaneous atrial fibrillation. Immediate and long-term results. Circulation. 1997 Jul 1;96(1):253–259. doi: 10.1161/01.cir.96.1.253. [DOI] [PubMed] [Google Scholar]
  14. Lévy S., Ricard P., Lau C. P., Lok N. S., Camm A. J., Murgatroyd F. D., Jordaens L. J., Kappenberger L. J., Brugada P., Ripley K. L. Multicenter low energy transvenous atrial defibrillation (XAD) trial results in different subsets of atrial fibrillation. J Am Coll Cardiol. 1997 Mar 15;29(4):750–755. doi: 10.1016/s0735-1097(96)00583-9. [DOI] [PubMed] [Google Scholar]
  15. MORRIS J. J., Jr, KONG Y., NORTH W. C., MCINTOSH H. D. EXPERIENCE WITH "CARDIOVERSION" OF ATRIAL FIBRILLATION AND FLUTTER. Am J Cardiol. 1964 Jul;14:94–100. doi: 10.1016/0002-9149(64)90112-2. [DOI] [PubMed] [Google Scholar]
  16. Murgatroyd F. D., Slade A. K., Sopher S. M., Rowland E., Ward D. E., Camm A. J. Efficacy and tolerability of transvenous low energy cardioversion of paroxysmal atrial fibrillation in humans. J Am Coll Cardiol. 1995 May;25(6):1347–1353. doi: 10.1016/0735-1097(94)00555-5. [DOI] [PubMed] [Google Scholar]
  17. Omran H., Jung W., Rabahieh R., Schimpf R., Wolpert C., Hagendorff A., Fehske W., Lüderitz B. Left atrial chamber and appendage function after internal atrial defibrillation: a prospective and serial transesophageal echocardiographic study. J Am Coll Cardiol. 1997 Jan;29(1):131–138. doi: 10.1016/s0735-1097(96)00439-1. [DOI] [PubMed] [Google Scholar]
  18. Powell A. C., Garan H., McGovern B. A., Fallon J. T., Krishnan S. C., Ruskin J. N. Low energy conversion of atrial fibrillation in the sheep. J Am Coll Cardiol. 1992 Sep;20(3):707–711. doi: 10.1016/0735-1097(92)90028-l. [DOI] [PubMed] [Google Scholar]
  19. Schmitt C., Alt E., Plewan A., Ammer R., Leibig M., Karch M., Schömig A. Low energy intracardiac cardioversion after failed conventional external cardioversion of atrial fibrillation. J Am Coll Cardiol. 1996 Oct;28(4):994–999. doi: 10.1016/s0735-1097(96)00274-4. [DOI] [PubMed] [Google Scholar]
  20. Sopher S. M., Murgatroyd F. D., Slade A. K., Blankoff I., Rowland E., Ward D. E., Camm A. J. Low energy internal cardioversion of atrial fibrillation resistant to transthoracic shocks. Heart. 1996 Jun;75(6):635–638. doi: 10.1136/hrt.75.6.635. [DOI] [PMC free article] [PubMed] [Google Scholar]

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