Electrical cardioversion of patients with implanted pacemaker or cardioverter–defibrillator: results of a survey of german centers and systematic review of the literature

Abstract

In this nationwide snapshot survey of cardioversion procedures in Germany, approximately 11% of patients presenting for elective electrical cardioversion were pacemaker or ICD carriers. Cardioversion protocols in these patients are heterogeneous throughout centers and mostly not in accordance with recommendation of the German Cardiac Society. Complications associated with external electrical cardioversion are rare. Controlled trials and large registries are necessary to provide evidence for future recommendations.

External Defibrillation/Cardioversion Protocol in Patients With an Implanted Cardioverter Defibrillator or Pacemaker: Systematic Review and Meta-Analysis

“…Following assessment of the full-text articles, 5 were excluded for reasons such as: rates of CIED complications were given. This left us with 4 prospective studies and 1 survey to be included in the analysis [11][12][13][14][15] (Table 1). The final population for the meta-analysis included 2077 patients.…”

“…In contrast, the consultants and ASA members agree with the recommendation that if ECV or ED is required, attempt to keep the CIED at least 10 cm away and out of the shock wave [34] . Our meta-analysis of literature [11][12][13][14][15] , suggest that the general precautions for ECV and ED in patients with CIED attempt to minimize the current delivered to the CIED system by using the minimal effective energy setting and placing the defibrillator paddles at least 10 cm away from the CIED, ensuring that the paddles are placed perpendicular to the dipole of the pacing system. When placing the adhesive pads on the patients chest, the goal is to "sandwich" the heart (Figure 4B1,4B2) [34] .…”

“…Moreover, in the case report of Filipovic et al [44] ECV in patient with a preexisting TPS no complications and no significant changes in device parameters in comparison to the preacquired values were observed. In the survey of Lüker et al [14] , based of German Cardiac Society guidelines [34] , the reported incidence of shock associated complications during ECV was only 0.6%, despite the fact that 38% of centers perform ECV with an anterolateral shock orientation and 28% of centers chose a first shock energy of 200 J. If the implanted PM delivers a synchronized low-energy shock in the attempt to use an ECV, it will simply be necessary to wait for 30 to 60 seconds for the PM to complete the shock.…”

“…Numerous case reports on direct external cardioversion (ECV) associated complications in PM patients exist, with many of them occurring in older devices and unipolar leads after monophasic shocks with an antero-lateral shock orientation [8][9][10] . Only few prospective reports with a small number of patients have been published, revealing no relevant adverse events in patients with contemporary leads and devices after ECV [11][12][13][14][15] . In this study we performed a systematic review and meta-analysis on the occurrence of complications of ECV and external defibrillation (ED) in patients with cardiac implanted electrical devices (CIED) implanted from 2000 to 2021.…”

Late ventricular pacemaker lead perforation after electrical cardioversion—A case report

“…In contemporary reports CIED complications after ECV are rare (<1%) and limited to transient increases in pacing threshold. 10 In a retrospective, multicenter registry, data on 16,554 patients undergoing ECV were collected, of which 1809 (10.9%) patients had a CIED. 10 Complications were reported in 11 (0.6%) patients with a CIED, all of which were transient elevations in pacing thresholds.…”