A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion

Alt, Eckhard; Ammer, Richard; Schmitt, Claus; Evans, F.G.; Lehmann, G.; Pasquantonio, Jay; Schömig, Albert

doi:10.1093/oxfordjournals.eurheartj.a015175

Cited by 72 publications

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“…The rate of SR maintenance after low-energy ICV has varied from 32% to 71% at 6 to 15 months. 6,7,9,13,14,17,[19][20][21][22][23] The variation in these numbers is due to the different types of antiarrhythmic drugs utilized and the different patient populations studied. Our 23% rate of SR at 18 months in the ICV group is lower than these figures.…”

Section: Discussionmentioning

confidence: 99%

“…25) The only trial that compared low-energy ICV to TT CV in a prospective fashion included 187 patients with chronic AF. 9) It is important to note that this trial was not randomized and the initial CV modality was left to the patient's choice and crossover to the alternative strategy was allowed in case of CV failure with the initial strategy. The acute success was significantly greater with the ICV modality (93% versus 79%, P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…Internal CV (ICV), a rather new technique, is performed by intracardiac electrodes introduced transvenously and especially with biphasic shock waveforms, allows successful CV with very low energy levels. [4][5][6][7][8][9] We have previously published data regarding a comparison of these 2 methods of CV with respect to immediate success. 10) This report describes the longterm follow-up of this prospective randomized comparison.…”

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confidence: 99%

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Prospective Randomized Trial of Transthoracic Versus Low-Energy Internal Cardioversion in Persistent Atrial Fibrillation Long Term Follow-up

et al. 2006

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SUMMARYLow energy internal cardioversion (ICV) is a relatively new method. This report describes the long-term follow-up results of a prospective randomized comparison of low energy ICV and transthoracic cardioversion (TT CV) in patients with persistent atrial fibrillation (AF).Fifty-two patients (mean age, 60.6 ± 10.1 years, 23 males) with persistent AF were randomly assigned to either TT (n = 26) or ICV (n = 26). The baseline characteristics of the 2 groups were similar. Transthoracic CV was performed under sedation with handheld electrodes in the apex-anterior position and high energy (100-360 J) monophasic shocks. ICV was performed by a dedicated balloon-directed catheter utilizing truncated, biphasic shocks of low energy (1-15 J).Sinus rhythm (SR) was restored in 24/26 (92%) patients in the ICV group and in 22/ 26 (85%) patients in the TT CV group (P > 0.05). Immediate recurrence of AF (IRAF), defined as reappearance of AF within 2 minutes of successful CV, occurred in 5 patients (21%) in the ICV group and in 1 patient (4.5%) in the TT group (P > 0.05). Successfully cardioverted patients in whom no IRAF occurred were followed-up for 18 months under both warfarin and Class 1 or 3 antiarrhythmic drugs, as guided by the current ACC/AHA/ ESC Guidelines. The rate of SR at 1, 3, 6, 12, and 18 months of follow-up was not significantly different between the 2 groups, and in an intention-to-treat analysis at 18 months, SR was present in 6 patients (23%) in the ICV group and in 10 patients (38%) in the TT group (P > 0.05). The majority of AF recurrences occurred within a month of successful CV in both groups (8/12 [67%] in the TT group and 15/18 [83%] in the ICV group, P > 0.05). The mortality, thromboembolic, and bleeding complication rates were similar in the 2 groups.In this prospective randomized comparison of TT and low energy ICV in patients with persistent AF, the 18-month rates of SR and major adverse clinical events were found to be similar. (Int Heart J 2006; 47: 753-762)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Prospective Randomized Trial of Transthoracic Versus Low-Energy Internal Cardioversion in Persistent Atrial Fibrillation Long Term Follow-up

et al. 2006

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“…The method has been proven to be safe and of benefit with respect to primary success rate and long-term effects. [3][4][5][6] The introduction of new therapeutic approaches in the treatment of patients is generally justified by greater efficiency and Clin. Cardiol.…”

Section: Introductionmentioning

confidence: 99%

Treatment satisfaction of internal versus external cardioversion in patients with chronic atrial fibrillation—A randomized, prospective, 28‐day follow‐up study

Ladwig¹,

Lehmann

Marten‐Mittag³

et al. 2003

Clinical Cardiology

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SummaryBackground and hypothesis: The use of internal cardioversion (IC) in chronic atrial fibrillation (AF) may be limited by procedure-related distress. This procedure may be efficacious but is not necessarily perceived as satisfactory by the patient because of the frequent procedure-related distress.Methods: We compared treatment satisfaction in 55 patients with chronic AF referred for cardioversion (CV). Satisfaction with conventional external cardioversion (EC, n = 27) and low-energy IC (n = 28) was compared immediately after the approach and at 28-day follow-up.Results: Four hours after CV, satisfaction scores (ranging from 0 to 7) were higher with EC (mean 6.1 standard deviation [SD] ± 1.4) versus IC (m = 5.4 SD ± 1.8) (p = 0.09). At 28 days, treatment satisfaction decreased in EC (m = 5.5 SD ± 2.1) and increased in the IC group (5.7 SD ± 1.8) because of a decrease in the trustful attitude subscale (p = 0.026) followed by tolerance for distressing factors (p = 0.059). The analysis of variance for repeated measures revealed a significant time by method interaction effect (p = 0.04). Patients prone to developing low treatment satisfaction (LTS) at follow-up were more

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“…1,2 Antiarrhythmic drugs and curative surgical and ablative therapies are still of limited efficacy, and their incidence of adverse effects is not insignificant. [3][4][5] Because cardioversion with intrathoracic electrodes is more efficacious than transthoracic defibrillation 6 and the implantable atrial defibrillator has been shown to be feasible, 7 many recent investigations have focused on minimizing the energy requirements of internal cardioversion through novel waveforms or electrode configurations. 8 -12 Still, the most efficient cardioversion strategy clinically used, with biphasic waveforms and lead systems in which shock fields encompass both atria, requires shock strengths that are not sufficiently low to be tolerated by most patients without sedation.…”

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Reduction of Atrial Defibrillation Threshold With an Interatrial Septal Electrode

et al. 2000

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Background-The standard lead configuration for internal atrial defibrillation consists of a shock between electrodes in the right atrial appendage (RAA) and coronary sinus (CS). We tested the hypothesis that the atrial defibrillation threshold (ADFT) of this RAA3 CS configuration would be lowered with use of an additional electrode at the atrial septum (SP). Methods and Results-Sustained atrial fibrillation was induced in 8 closed-chest sheep with burst pacing and continuous pericardial infusion of acetyl-␤-methylcholine. Defibrillation electrodes were situated in the RAA, CS, pulmonary artery (PA), low right atrium (LRA), and across the SP. ADFTs of RAA3 CS and 4 other lead configurations were determined in random order by use of a multiple-reversal protocol. Biphasic waveforms of 3/1-ms duration were used for all single and sequential shocks. The ADFT delivered energies for the single-shock configurations were 1.27Ϯ0.67 J for RAA3 CS and 0.86Ϯ0.59 J for RAAϩCS3 SP; the ADFTs for the sequential-shock configurations were 0.39Ϯ0.18 J for RAA3 SP/CS3 SP, 1.16Ϯ0.72 J for CS3 SP/RAA3 SP, and 0.68Ϯ0.46 J for RAA3 CS/LRA3 PA. Except for CS3 SP/RAA3 SP versus RAA3 CS and RAA3 CS/LRA3 PA versus RAAϩCS3 SP, the ADFT delivered energies of all of the configurations were significantly different from each other (PϽ0.05). Conclusions-The ADFT of the standard RAA3 CS configuration is markedly reduced with an additional electrode at the

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A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion

Abstract: Internal cardioversion is effective in restoring sinus rhythm. It might be indicated in patients in whom external cardioversion had failed or in whom external cardioversion is assumed to be difficult or even contraindicated.

Cited by 72 publications

References 0 publications

Prospective Randomized Trial of Transthoracic Versus Low-Energy Internal Cardioversion in Persistent Atrial Fibrillation Long Term Follow-up

Prospective Randomized Trial of Transthoracic Versus Low-Energy Internal Cardioversion in Persistent Atrial Fibrillation Long Term Follow-up

Treatment satisfaction of internal versus external cardioversion in patients with chronic atrial fibrillation—A randomized, prospective, 28‐day follow‐up study

Reduction of Atrial Defibrillation Threshold With an Interatrial Septal Electrode

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