Transoesophageal low-energy cardioversion of atrial fibrillation. Results with the oesophageal–right atrial lead configuration

Abstract

BackgroundLow energy internal cardioversion is a safe and effective procedure to restore sinus rhythm in patients with atrial fibrillation refractory to external cardioversion. However the procedure is invasive and fluoroscopy is mandatory.Aim of the study To assess the efficacy, safety and tolerability of a new simplified procedure of low energy internal cardioversion.Methods Twenty-five consecutive patients (19 males and 6 females) with persistent atrial fibrillation were submitted to low energy internal cardioversion using a step-up protocol (in steps of 50 V, starting from 300 V). A large surface area lead (cathode) was positioned in the oesophagus, 45 cm from the nasal orifice. A second large surface area lead (anode) was positioned in the right atrium. A quadripolar lead was positioned at the right ventricular apex to achieve ventricular synchronization and back-up pacing. Oesophageal endoscopy was performed within 24 h of the end of the procedure and repeated after 48 h, if injury to the oesophageal mucosa had occurred.Results Sinus rhythm was restored in 23 patients (92%) with a mean delivered energy of 15·74 J (range 5-27) and a mean impedance of 48 . In two patients, endoscopy revealed that small burns had occurred in the oesophageal mucosa. Such lesions spontaneously healed after 48 h. ConclusionsThis new technique of performing low energy internal cardioversion is effective and safe and avoids the positioning of a lead in the coronary sinus or in the left pulmonary artery, thereby simplifying the procedure.

Single-Step Atrial Thrombus Exclusion and Internal Cardioversion of Atrial Fibrillation Via a Transesophageal Echocardiography Probe

“…Our experimental and clinical data and recent studies have shown that the reed switch remains open in up to 50% of all orientations of the pacemaker device even in the strong static magnetic field of a 1.5-t magnetic resonance system (2,3). This may have important clinical implications, because if the reed switch is open potentially harmful false inhibition or false triggering of the pacemaker by the pulsed…”

“…The simplicity of the combined CV/ imaging system and its ease of use distinguish this approach from previous transesophageal CV attempts. These investigations employed esophageal CV catheters, which were mostly positioned under fluoroscopic control (3)(4)(5). Some included atrial CV electrodes (3,6) or delivered shocks between esophageal and cutaneous electrodes (4,5) or mere esophageal electrodes (5,7).…”

“…These investigations employed esophageal CV catheters, which were mostly positioned under fluoroscopic control (3)(4)(5). Some included atrial CV electrodes (3,6) or delivered shocks between esophageal and cutaneous electrodes (4,5) or mere esophageal electrodes (5,7). The approach presented herein also differs from a recent report on transesophageal CV in patients with CV electrodes embedded permanently in a novel TEE-probe (8) as the disposable CV electrode sheath can be affixed to any conventional TEE probe already available in the hospitals.…”

Transthoracic Versus Transesophageal Cardioversion of Atrial Fibrillation under Light Sedation: A Prospective Randomized Trial

“…No damage was seen and no symptoms occurred in patients who received 100 J or less. Santini et al 13 performed endoscopy in patients who had received shocks of up to 27 J and showed only transient mild erythema of the esophageal mucosa.…”

Esophageal Electrical Cardioversion of Atrial Fibrillation: When Esophagus Gives a Help to Cardiologists

“…Many studies, in more than 40 years of esophageal cardioversion, have proven safety of such technique, performing even histological examination of the esophageal mucosa in the animals underwent to esophageal shocks [5] or esophageal endoscopy in patients underwent to the esophageal-intracardiac cardioversion [6]. McKeown et al [7] showed that no damage or dysphagia was seen in patients receiving shocks less than 100 joules.…”