External cardioversion of atrial fibrillation and flutter in patients with cardiac implantable electrical devices

Abstract

Background Atrial fibrillation and flutter are often treated with external electrical cardioversion (ECV) in patients with potentially electrically sensitive cardiovascular implantable electronic devices (CIED). Long‐term follow‐up data on contemporary CIED undergoing ECV is sparse. The aim is to investigate shock‐related complications and impact on CIEDs. Methods All ECV procedures from 2010 to 2020 in patients with CIED performed at a tertiary university hospital were identified in the Danish National Patient Registry. Changes in device measurements after ECV were retrospectively studied and procedure‐related complications were identified by review of medical records. Results We analyzed 763 ECV procedures in 372 patients, median device implant time 1.9 years. The mean age of patients was 69.9 ± 9.9 years of which 73.4% were men. We identified two cases of device programming changes and four cases of premature battery depletion (≤3 years after device implant). Minor changes in device measurements were found for impedances, sensing, and pacing thresholds. No patients died due to ECV‐related device dysfunctions within the first 12 months after cardioversions. Conclusion External cardioversion in patients with contemporary pacemakers and implantable cardioverter‐defibrillators seems safe in the majority of patients. Clinically important changes in device function following cardioversion were rarely observed but may be critical for device function. In an observational study, causality between cardioversion and device dysfunction cannot be established. For patient safety, we suggest that routine device interrogation after cardioversion still should be part of standard care.

External cardioversion in patients with cardiovascular implantable electronic devices: An epidemiological and experimental study series

“…Based on the results from Study I, we found two cases (0.5%) of device programming changes and four cases (1.0%) of premature battery depletion (89). These cases with programming changes were critical for device function and were avoided because of routine immediate interrogations.…”

“…We analysed in total 763 ECV procedures involving 395 CIED generators in 372 patients (89). The mean patient age was 69.9 ± 9.9 years and 73.4% were male.…”

“…After the study results are analysed for internal validity, the consideration of external validity is relevant. In Study I, we analysed an unselected study population of CIED patients undergoing ECV treatments between 2010-2020 and at one centre (89). The study findings seemed representative for other patients treated with comparable clinical ECV setup and CIED systems.…”

“…study populations varied between the two register-based studies from singlecentre analytic study in the North Denmark Region in Study I to nationwide, multicentre cohort study in Study II.In Study I, which was analytic study, the study population of was CIED patients undergoing ECV treatments at Aalborg University Hospital between January 01, 2010, and December 31, 2020(89). We included 372 patients and 763 ECV procedure after patients with CIED implanted before January 01, 2005, loop recorders, external pacing devices, subcutaneous-ICDs and leadless PMs were excluded.…”