Double external direct-current shocks for refractory atrial fibrillation

Bjerregaard, Preben; El-Shafei, Amr; Janosik, Denise L.; Schiller, L.; Quattromani, Antonella

doi:10.1016/s0002-9149(98)01048-0

Cited by 32 publications

(28 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…DCC has remained the most effective method for terminating AF since its introduction nearly 4 decades ago [19] – it fails to restore sinus rhythm in <20% of treated patients [20], and it is considered a safe procedure. Our findings, among stable patients with AF <48 h or with INR 2–5, indicate that DCC is the treatment of choice in comparison to pharmacological cardioversion or no cardioversion at all, in respect to its success to restore the conduction rhythm to sinus.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

et al. 2008

View full text Add to dashboard Cite

Objective: To compare the success rates and short-term complications of three treatment approaches, pharmacological and direct-current cardioversion (DCC), or ‘wait-and-watch’ among stable atrial fibrillation (AF) patients in the emergency department (ED). Methods: All AF-related ED admissions during a 1-year period were retrospectively reviewed, and those meeting criteria of eligibility for immediate cardioversion, based on clinical stability, AF duration and adequacy of anticoagulation, were included. The propensity score approach generalized for the three groups was used to adjust for the observational non-randomized study nature. Results: Among 374 eligible patients, the rate of successful cardioversion was higher in DCC than in pharmacological or wait-and-watch groups (78.2, 59.2 and 37.9% respectively, p < 0.001), with corresponding percentages of patients discharged from ED (52.9, 47.9 and 32.1%, p < 0.01) and respective odds ratios of 6.00, 2.47 and 1, adjusting for seniority of the treating physician, age, gender and patient comorbidities. DCC was 2.43 times more effective than pharmacological treatment in achieving sinus rhythm (95% confidence interval = 1.36–4.33, p = 0.003). Rehospitalization within 14 days due to probable AF-treatment-related complications of home-discharged patients was 3.4%. Conclusions: DCC was found to be the most effective treatment, with few short-term complications following conversion of stable AF patients to sinus rhythm in the ED.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

et al. 2008

View full text Add to dashboard Cite

show abstract

“…21 High energies have been safely delivered in experimental and clinical AF, with energies as high as 720 J applied externally. 23 Acute pulmonary edema has been reported after electrical cardioversion of AF in humans. 24 This complication is considered rare.…”

Section: Discussionmentioning

confidence: 99%

Transvenous Electrical Cardioversion of Equine Atrial Fibrillation Technical Considerations

Kimberly

McGurrin

Physick‐Sheard

et al. 2005

Journal of Veterinary Internal Medicine

View full text Add to dashboard Cite

Conventional treatment of equine atrial fibrillation (AF) involves administration of quinidine salts. Most uncomplicated cases respond to treatment, but pharmacologic cardioversion involves a range of adverse effects, and some horses are unable to tolerate medication. A study was undertaken to develop transvenous electrical cardioversion (TVEC) as an alternative treatment. Safety issues and catheter placement techniques with catheter-integrated cardioversion electrodes were investigated, and responses to shock application were evaluated. After the premortem catheterization of elective-euthanasia horses, no tissue abnormalities were detected at postmortem examination. To evaluate the response to the application of shocks and appropriate electrode positions, an electrical cardioversion of research horses in chronic AF was then attempted. After catheterization of the right atrium (RA) and pulmonary artery through the right jugular vein, horses were placed under general anesthesia. Biphasic, truncated exponential shock waves were delivered at incremental energies until cardioversion was achieved or until a maximum energy of 300 J was reached. Five treatment events were applied to 3 horses, with cardioversion achieved in one of the treatment events. No adverse effects of cardioversion attempts or general anesthesia were observed. The procedure was then applied to 8 client-owned horses, with cardioversion achieved in 7. No adverse responses to appropriately delivered shocks were observed. No antiarrhythmic medications were administered to any horse at any stage. Catheter design and placement technique evolved throughout the study, with combined ultrasonography and pressure guidance proving most effective in achieving appropriate electrode placement. Results suggest TVEC, as applied in the present study, is a safe, effective, and realistic therapeutic option for equine AF.Key words: Cardiac disease; Electrophysiology; Heart; Horse. Management of atrial fibrillation (AF) in horses has traditionally involved the administration, PO and, more recently, IV, of a quinidine salt.1-4 The treatment is effective in approximately 80% of horses but involves a range of dose-related and idiosyncratic toxic responses varying from mild and benign to fatal.1-4 Additional therapeutic modalities are required to avoid these adverse effects and to provide options for those horses that fail to respond to, or are intolerant of, quinidine salts.Electrical cardioversion involves the application of electrical shock (with a defibrillator) with the goal of depolarizing all or part of the atrial myocardium. Electrical cardioversion of AF is becoming routine in human medicine, because the efficacy of this modality is often higher than that of pharmacologic methods for the restoration of sinus rhythm.5 In humans, lower energy requirements and higher efficacy have been reported with internal electrical cardioversion with catheter-mounted electrodes (transvenous electrical cardioversion [TVEC]) than with external techniques with thoracic paddles, 5-7 ...

show abstract

“…Bjerregarrd and coworkers. 20) used this technique for refractory AF to single shock DC cardioversion with a 67% success rate. Marrouche and coworkers 21) also examined the efficacy of two simultaneous 360-J shocks to convert refractory AF.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

et al. 2004

View full text Add to dashboard Cite

SUMMARYAtrial fibrillation (AF) has been treated with DC shocks delivered transthoracically, but in 5-30% of patients, the procedures fail to restore sinus rhythm (SR). We hypothesized that applying high energy shock waves to the chest may overcome the inadequate penetration of electrical shock to the atrium. The aim of this study was to evaluate the efficacy of higher energy external DC shock for the treatment of refractory AF coexisting with cardiovascular disease using a synchronized double external defibrillator.Fifteen patients (mean age 65 ± 8) with refractory AF to standard DC cardioversion (CV) underwent higher energy DC shock using a double external defibrillator. Concomitant heart disease was present in all patients. Warfarin and amiodarone (600 mg/day), were administered for at least three weeks duration before DC CV. Sedation was performed with IV midazolam. Two defibrillator paddles were positioned on the anterior and posterior chest wall in a right lateral decubitus position. Defibrillators were synchronized to the R waves and simultaneously 720 joules of energy was administered to the patients. Amiodarone (200 mg/day) was continuously administered after DC shock to maintain SR.Sinus rhythm was obtained in 13 patients. Sinus rhythm was persistent in 11 patients for six months duration. Creatine kinase MB fractions were normal at 4 (22 ± 4 IU/L) and 12 hours (18 ± 4 IU/L). None of the patients developed significant hemodynamic compromise or congestive heart failure, higher AV block, stroke, or transient ischemic cerebral events.The results indicate that higher energy DC shock application using a double external defibrillator is an effective and safe method for the cardioversion of refractory AF. We believe this procedure should be performed before internal atrial cardioversion. (Jpn Heart J 2004; 45: 929-936)

show abstract

Double external direct-current shocks for refractory atrial fibrillation

Cited by 32 publications

References 11 publications

Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

Treatment of Stable Atrial Fibrillation in the Emergency Department: A Population-Based Comparison of Electrical Direct-Current versus Pharmacological Cardioversion or Conservative Management

Transvenous Electrical Cardioversion of Equine Atrial Fibrillation Technical Considerations

Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

Contact Info

Product

Resources

About