Feasibility and efficacy of electrical cardioversion after cardiac resynchronization implantation in patients with permanent atrial fibrillation

Turco, Pietro; D’Onofrio, Antonio; Stabile, Giuseppe; Solimene, Francesco; Rocca, Vincenzo La; Vecchione, F.; Iuliano, Assunta; Marrazzo, Natale; Vivo, Stefano De; Cavallaro, Ciro; Bianchi, Valter; Agresta, Alessia; Ciardiello, Carmine; Simone, Antonio De

doi:10.1007/s10840-012-9713-2

Cited by 11 publications

(11 citation statements)

References 17 publications

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“…Two studies showed high cardioversion efficacy of ICD shocks in patients with paroxysmal or acutely induced AF [ 6 , 7 ]. Turco et al [ 4 ] evaluated cardioversion efficacy of ICD shocks in patients with a CRT-D device and permanent AF for more than 1 year. They found that 82 % of patients could be converted to stable sinus rhythm.…”

Section: Discussionmentioning

confidence: 99%

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Low efficacy of cardioversion of persistent atrial fibrillation with the implantable cardioverter-defibrillator

et al. 2013

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AimsAtrial fibrillation (AF) and heart failure are conditions that often coexist. Consequently, many patients with an implantable cardioverter-defibrillator (ICD) present with AF. We evaluated the effectiveness of internal cardioversion of AF in patients with an ICD.MethodsRetrospectively, we included 27 consecutive ICD patients with persistent AF who underwent internal cardioversion using the ICD. When ICD cardioversion failed, external cardioversion was performed.ResultsPatients were predominantly male (89 %) with a mean (SD) age of 65 ± 9 years and left ventricular ejection fraction of 36 ± 17 %. Only nine (33 %) patients had successful internal cardioversion after one, two or three shocks. The remaining 18 patients underwent external cardioversion after they failed internal cardioversion, which resulted in sinus rhythm in all. A smaller left atrial volume (99 ± 36 ml vs. 146 ± 44 ml; p = 0.019), a longer right atrial cycle length (227 (186–255) vs. 169 (152–183) ms, p = 0.030), a shorter total AF history (2 (0–17) months vs. 40 (5–75) months, p = 0.025) and dual-coil ICD shock (75 % vs. 26 %, p = 0.093) were associated with successful ICD cardioversion.ConclusionInternal cardioversion of AF in ICD patients has a low success rate but may be attempted in those with small atria, a long right atrial fibrillatory cycle length and a short total AF history, especially when a dual-coil ICD is present. Otherwise, it seems reasonable to prefer external over internal cardioversion when it comes to termination of persistent AF.

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Section: Discussionmentioning

confidence: 99%

“…In patients with an implantable cardioverter-defibrillator (ICD), AF can be cardioverted with a synchronised internal shock from the ICD. Only limited data are available on the efficacy of internal ICD cardioversion for AF [ 4 ]. In the present study, we evaluated the effectiveness of internal cardioversion of AF in ICD patients.…”

Section: Introductionmentioning

confidence: 99%

Low efficacy of cardioversion of persistent atrial fibrillation with the implantable cardioverter-defibrillator

et al. 2013

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“…It is usually achieved through external cardioversion, but the presence of ICD gives an option to perform it through the implanted device as well. In fact, this approach was tested in small studies of patients with CRT-D 70 and ICD only, 71 where restoration of the sinus rhythm was achieved in 82% of cases, with only nonsignificantly better results of external cardioversion.…”

Section: Implantable Cardioverter-defibrillators In the Management Of Afmentioning

confidence: 99%

Nonpharmacological Treatment of Atrial Fibrillation: What Is the Role of Device Therapy?

et al. 2020

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Atrial fibrillation is the most common arrhythmia in the adult population, and its incidence and prevalence are still rising. Cardiac devices are widely used in clinical practice in the management of various rhythm disturbances and heart failure treatment. Many patients who receive a pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy also experience atrial fibrillation in the course of their life. Therefore, this review aims to describe the role of these devices in the treatment and prevention of atrial fibrillation in the device recipients. In addition, all these implantable devices also serve as permanent ECG (electrocardiogram) monitors, thus providing important information about the presence and characteristics of atrial fibrillation that may or may not be detected by the patient but can modify our therapeutical approach with regard to the stroke prevention.

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“…The only trial upon this issue was the non-randomized, cohort study of Turco et al . [ 17 ], which has shown a positive effect on end-diastolic volume in the rhythm control group, whereas the influence on ejection fraction was comparable between the rhythm and the rate control groups.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the rhythm control treatment strategy versus the rate control strategy in patients with permanent or long-standing persistent atrial fibrillation and heart failure treated with cardiac resynchronization therapy - a pilot study of Cardiac Resynchronization in Atrial Fibrillation Trial (Pilot-CRAfT): study protocol for a randomized controlled trial

Ciszewski

Maciąg

Kowalik

et al. 2014

Trials

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BackgroundThe only subgroups of patients with heart failure and atrial fibrillation in which the efficacy of cardiac resynchronization therapy has been scientifically proven are patients with indications for right ventricular pacing and patients after atrioventricular junction ablation. However it is unlikely that atrioventricular junction ablation would be a standard procedure in the majority of the heart failure patients with cardiac resynchronization therapy and concomitant atrial fibrillation due to the irreversible character of the procedure and a spontaneous sinus rhythm resumption that occurs in about 10% of these patients.Methods/DesignPilot-CRAfT is the first randomized controlled trial evaluating the efficacy of a rhythm control strategy in atrial fibrillation patients with cardiac resynchronization therapy devices. The aim of this prospective, single center randomized controlled pilot study is to answer the question whether the patients with cardiac resynchronization therapy and permanent atrial fibrillation would benefit from a strategy to restore and maintain sinus rhythm (that is ‘rhythm control’ strategy) in comparison to rate control strategy. The study population consists of 60 patients with heart failure and concomitant long-standing persistent or permanent atrial fibrillation who underwent a cardiac resynchronization therapy device implantation at least 3 months before qualification. Study participants are randomly assigned to the rhythm control strategy (including electrical cardioversion and pharmacotherapy) or to the rate control group whose goal is to control ventricular rate. The follow-up time is 12 months. The primary endpoint is the ratio of effectively captured biventricular beats. The secondary endpoints include peak oxygen consumption, six-minute walk test distance, heart failure symptom escalation, reverse remodelling of the heart on echo and quality of life.Trial registrationNCT01850277 registered on 22 April 2013 (ClinicalTrails.gov)

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Feasibility and efficacy of electrical cardioversion after cardiac resynchronization implantation in patients with permanent atrial fibrillation

Cited by 11 publications

References 17 publications

Low efficacy of cardioversion of persistent atrial fibrillation with the implantable cardioverter-defibrillator

Low efficacy of cardioversion of persistent atrial fibrillation with the implantable cardioverter-defibrillator

Nonpharmacological Treatment of Atrial Fibrillation: What Is the Role of Device Therapy?

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