Low-energy cardioversion of spontaneous atrial fibrillation : Immediate and long-term results
Recent studies have suggested that induced atrial fibrillation (AF) could be successfully terminated by using a two-catheter electrode system and low energy (< 400 V). This study evaluated the efficacy and safety of low-energy cardioversion in spontaneous chronic and paroxysmal AF. Forty-two cons...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1997-07, Vol.96 (1), p.253-259 |
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| creator | LEVY, S RICARD, P GUEUNOUN, M YAPO, F TRIGANO, J MANSOURI, C PAGANELLI, F |
| description | Recent studies have suggested that induced atrial fibrillation (AF) could be successfully terminated by using a two-catheter electrode system and low energy (< 400 V). This study evaluated the efficacy and safety of low-energy cardioversion in spontaneous chronic and paroxysmal AF.
Forty-two consecutive patients with spontaneous AF underwent low-energy electrical cardioversion. AF was chronic (> or = 1 month) with a mean duration of 9 +/- 19 months in 28 patients (group I) or paroxysmal with a history of recurrent attacks and a mean duration of the present episode of 7 +/- 16 days in 14 patients (group II). An underlying heart disease was present in 28 patients. A 3/3-ms biphasic shock was delivered between catheters positioned in the right atrium and the coronary sinus in 32 patients. In 10 patients, the left pulmonary artery branch was used. The catheters were connected to a custom external defibrillator. The shocks were synchronized to the R wave. Following a test shock of 60 V, the energy was increased in 40-V steps until a maximum of 400 V or restoration of sinus rhythm. Sinus rhythm was restored in 22 of the 28 patients (78%) of group I by using a mean leading-edge voltage of 297 +/- 57 V (mean energy 3.3 +/- 1.3 J) and in 11 of 14 patients (78%) of group II by using a mean leading-edge voltage of 223 +/- 41 V (mean energy, 1.8 +/- 0.7 J). The energy required for terminating chronic AF was significantly (P < .001) higher than that required for terminating paroxysmal AF. Among the other variables studied, the duration of AF significantly affected the successful voltage. Ventricular proarrhythmia occurred in 1 patient with atrial flutter due to an unsynchronized shock. Of the 22 patients of group I in whom sinus rhythm was restored, 14 (63%) remained in sinus rhythm with a mean follow-up of 9 +/- 3 months. Pain level showed a good correlation with increasing voltage. However, a marked inter-individual variation was noted.
Atrial defibrillation using low energy between two intracardiac catheters with an electrical field between the right and left atria and the protocol used is feasible in patients with persistent spontaneous AF. The technique is safe provided synchronization to the R wave is achieved. A low recurrence rate of AF was seen in patients in whom sinus rhythm was restored. |
| doi_str_mv | 10.1161/01.CIR.96.1.253 |
| format | Article |
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Forty-two consecutive patients with spontaneous AF underwent low-energy electrical cardioversion. AF was chronic (> or = 1 month) with a mean duration of 9 +/- 19 months in 28 patients (group I) or paroxysmal with a history of recurrent attacks and a mean duration of the present episode of 7 +/- 16 days in 14 patients (group II). An underlying heart disease was present in 28 patients. A 3/3-ms biphasic shock was delivered between catheters positioned in the right atrium and the coronary sinus in 32 patients. In 10 patients, the left pulmonary artery branch was used. The catheters were connected to a custom external defibrillator. The shocks were synchronized to the R wave. Following a test shock of 60 V, the energy was increased in 40-V steps until a maximum of 400 V or restoration of sinus rhythm. Sinus rhythm was restored in 22 of the 28 patients (78%) of group I by using a mean leading-edge voltage of 297 +/- 57 V (mean energy 3.3 +/- 1.3 J) and in 11 of 14 patients (78%) of group II by using a mean leading-edge voltage of 223 +/- 41 V (mean energy, 1.8 +/- 0.7 J). The energy required for terminating chronic AF was significantly (P < .001) higher than that required for terminating paroxysmal AF. Among the other variables studied, the duration of AF significantly affected the successful voltage. Ventricular proarrhythmia occurred in 1 patient with atrial flutter due to an unsynchronized shock. Of the 22 patients of group I in whom sinus rhythm was restored, 14 (63%) remained in sinus rhythm with a mean follow-up of 9 +/- 3 months. Pain level showed a good correlation with increasing voltage. However, a marked inter-individual variation was noted.
Atrial defibrillation using low energy between two intracardiac catheters with an electrical field between the right and left atria and the protocol used is feasible in patients with persistent spontaneous AF. The technique is safe provided synchronization to the R wave is achieved. A low recurrence rate of AF was seen in patients in whom sinus rhythm was restored.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.96.1.253</identifier><identifier>PMID: 9236442</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Arrhythmia Agents - therapeutic use ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - therapy ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Electric Countershock - adverse effects ; Electricity ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Humans ; Male ; Medical sciences ; Middle Aged ; Pain - etiology ; Prospective Studies ; Tachycardia, Paroxysmal - diagnosis ; Tachycardia, Paroxysmal - therapy ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 1997-07, Vol.96 (1), p.253-259</ispartof><rights>1997 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Jul 1, 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c342t-4ee63711fa71ac1de129d5a9eebda43b9323df0de4ba46a3c12d2193a1d5e5a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3686,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2771534$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9236442$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LEVY, S</creatorcontrib><creatorcontrib>RICARD, P</creatorcontrib><creatorcontrib>GUEUNOUN, M</creatorcontrib><creatorcontrib>YAPO, F</creatorcontrib><creatorcontrib>TRIGANO, J</creatorcontrib><creatorcontrib>MANSOURI, C</creatorcontrib><creatorcontrib>PAGANELLI, F</creatorcontrib><title>Low-energy cardioversion of spontaneous atrial fibrillation : Immediate and long-term results</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Recent studies have suggested that induced atrial fibrillation (AF) could be successfully terminated by using a two-catheter electrode system and low energy (< 400 V). This study evaluated the efficacy and safety of low-energy cardioversion in spontaneous chronic and paroxysmal AF.
Forty-two consecutive patients with spontaneous AF underwent low-energy electrical cardioversion. AF was chronic (> or = 1 month) with a mean duration of 9 +/- 19 months in 28 patients (group I) or paroxysmal with a history of recurrent attacks and a mean duration of the present episode of 7 +/- 16 days in 14 patients (group II). An underlying heart disease was present in 28 patients. A 3/3-ms biphasic shock was delivered between catheters positioned in the right atrium and the coronary sinus in 32 patients. In 10 patients, the left pulmonary artery branch was used. The catheters were connected to a custom external defibrillator. The shocks were synchronized to the R wave. Following a test shock of 60 V, the energy was increased in 40-V steps until a maximum of 400 V or restoration of sinus rhythm. Sinus rhythm was restored in 22 of the 28 patients (78%) of group I by using a mean leading-edge voltage of 297 +/- 57 V (mean energy 3.3 +/- 1.3 J) and in 11 of 14 patients (78%) of group II by using a mean leading-edge voltage of 223 +/- 41 V (mean energy, 1.8 +/- 0.7 J). The energy required for terminating chronic AF was significantly (P < .001) higher than that required for terminating paroxysmal AF. Among the other variables studied, the duration of AF significantly affected the successful voltage. Ventricular proarrhythmia occurred in 1 patient with atrial flutter due to an unsynchronized shock. Of the 22 patients of group I in whom sinus rhythm was restored, 14 (63%) remained in sinus rhythm with a mean follow-up of 9 +/- 3 months. Pain level showed a good correlation with increasing voltage. However, a marked inter-individual variation was noted.
Atrial defibrillation using low energy between two intracardiac catheters with an electrical field between the right and left atria and the protocol used is feasible in patients with persistent spontaneous AF. The technique is safe provided synchronization to the R wave is achieved. A low recurrence rate of AF was seen in patients in whom sinus rhythm was restored.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Electric Countershock - adverse effects</subject><subject>Electricity</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pain - etiology</subject><subject>Prospective Studies</subject><subject>Tachycardia, Paroxysmal - diagnosis</subject><subject>Tachycardia, Paroxysmal - therapy</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1r3DAQhkVpSDcf554KopTc7Hj0ZdRbWfqxsFAI7bGIsTUOCra1leyG_PtqmyWHnoZhnnl5eRh7C00NYOC2gXq7u6utqaEWWr5iG9BCVUpL-5ptmqaxVSuFeMMucn4oq5GtPmfnVkijlNiwX_v4WNFM6f6J95h8iH8o5RBnHgeeD3FecKa4Zo5LCjjyIXQpjCMuR-Qj300T-YALcZw9H-N8Xy2UJp4or-OSr9jZgGOm69O8ZD-_fP6x_Vbtv3_dbT_tq14qsVSKqPQCGLAF7METCOs1WqLOo5KdlUL6ofGkOlQGZQ_CC7ASwWvSaOQlu3nOPaT4e6W8uCnknkrPf-Vda0Gb1hzB9_-BD3FNc-nmBIhWQbFXoNtnqE8x50SDO6QwYXpy0LijddeAK9adNQ5csV4-3p1i164IeeFPmsv9w-mOucdxSDj3Ib9gom1BSyX_As2Hiuw</recordid><startdate>19970701</startdate><enddate>19970701</enddate><creator>LEVY, S</creator><creator>RICARD, P</creator><creator>GUEUNOUN, M</creator><creator>YAPO, F</creator><creator>TRIGANO, J</creator><creator>MANSOURI, C</creator><creator>PAGANELLI, F</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>19970701</creationdate><title>Low-energy cardioversion of spontaneous atrial fibrillation : Immediate and long-term results</title><author>LEVY, S ; RICARD, P ; GUEUNOUN, M ; YAPO, F ; TRIGANO, J ; MANSOURI, C ; PAGANELLI, F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c342t-4ee63711fa71ac1de129d5a9eebda43b9323df0de4ba46a3c12d2193a1d5e5a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Electric Countershock - adverse effects</topic><topic>Electricity</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pain - etiology</topic><topic>Prospective Studies</topic><topic>Tachycardia, Paroxysmal - diagnosis</topic><topic>Tachycardia, Paroxysmal - therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LEVY, S</creatorcontrib><creatorcontrib>RICARD, P</creatorcontrib><creatorcontrib>GUEUNOUN, M</creatorcontrib><creatorcontrib>YAPO, F</creatorcontrib><creatorcontrib>TRIGANO, J</creatorcontrib><creatorcontrib>MANSOURI, C</creatorcontrib><creatorcontrib>PAGANELLI, F</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LEVY, S</au><au>RICARD, P</au><au>GUEUNOUN, M</au><au>YAPO, F</au><au>TRIGANO, J</au><au>MANSOURI, C</au><au>PAGANELLI, F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low-energy cardioversion of spontaneous atrial fibrillation : Immediate and long-term results</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1997-07-01</date><risdate>1997</risdate><volume>96</volume><issue>1</issue><spage>253</spage><epage>259</epage><pages>253-259</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Recent studies have suggested that induced atrial fibrillation (AF) could be successfully terminated by using a two-catheter electrode system and low energy (< 400 V). This study evaluated the efficacy and safety of low-energy cardioversion in spontaneous chronic and paroxysmal AF.
Forty-two consecutive patients with spontaneous AF underwent low-energy electrical cardioversion. AF was chronic (> or = 1 month) with a mean duration of 9 +/- 19 months in 28 patients (group I) or paroxysmal with a history of recurrent attacks and a mean duration of the present episode of 7 +/- 16 days in 14 patients (group II). An underlying heart disease was present in 28 patients. A 3/3-ms biphasic shock was delivered between catheters positioned in the right atrium and the coronary sinus in 32 patients. In 10 patients, the left pulmonary artery branch was used. The catheters were connected to a custom external defibrillator. The shocks were synchronized to the R wave. Following a test shock of 60 V, the energy was increased in 40-V steps until a maximum of 400 V or restoration of sinus rhythm. Sinus rhythm was restored in 22 of the 28 patients (78%) of group I by using a mean leading-edge voltage of 297 +/- 57 V (mean energy 3.3 +/- 1.3 J) and in 11 of 14 patients (78%) of group II by using a mean leading-edge voltage of 223 +/- 41 V (mean energy, 1.8 +/- 0.7 J). The energy required for terminating chronic AF was significantly (P < .001) higher than that required for terminating paroxysmal AF. Among the other variables studied, the duration of AF significantly affected the successful voltage. Ventricular proarrhythmia occurred in 1 patient with atrial flutter due to an unsynchronized shock. Of the 22 patients of group I in whom sinus rhythm was restored, 14 (63%) remained in sinus rhythm with a mean follow-up of 9 +/- 3 months. Pain level showed a good correlation with increasing voltage. However, a marked inter-individual variation was noted.
Atrial defibrillation using low energy between two intracardiac catheters with an electrical field between the right and left atria and the protocol used is feasible in patients with persistent spontaneous AF. The technique is safe provided synchronization to the R wave is achieved. A low recurrence rate of AF was seen in patients in whom sinus rhythm was restored.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>9236442</pmid><doi>10.1161/01.CIR.96.1.253</doi><tpages>7</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 1997-07, Vol.96 (1), p.253-259 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adult Aged Aged, 80 and over Anti-Arrhythmia Agents - therapeutic use Atrial Fibrillation - diagnosis Atrial Fibrillation - therapy Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Electric Countershock - adverse effects Electricity Electrocardiography Female Follow-Up Studies Heart Humans Male Medical sciences Middle Aged Pain - etiology Prospective Studies Tachycardia, Paroxysmal - diagnosis Tachycardia, Paroxysmal - therapy Treatment Outcome |
| title | Low-energy cardioversion of spontaneous atrial fibrillation : Immediate and long-term results |
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