RT-137
|
External electrical
cardioversion: the first choice procedure not only in chronic atrial fibrillation
|
|
|
G. Molon, G. Canali, P. Girardi,
F. Castagna, G.L. Ferri, F. Stefanini*, G.C. Salazzari.
Department of Cardiology, *Department of Emergency, "S. Cuore"
Hospital, Negrar, Italy
|
|
Abstract
|
|
Is nowadays well know the importance of terminating
atrial fibrillation as soon as possible. Farmacologic attempts of cardioversion are often
ineffective or with low prediction of success in recent onset and, most important, even
less effective and predictable in chronic atrial fibrillation. We retrospectively
evaluated effectiveness and safety of external electrical cardioversion in atrial
fibrillation.
Methods. From January 1993 to June 1997 154 patients underwent 221
cardioversions for atrial fibrillation. 121 patients with onset > 48 hours or
moderate/severe risk of stroke, were anticoagulated with Warfarin to obtain a prothrombin
time (INR) range between 2 and 3 for 3 weeks before cardioversion; which was not taken
before 1 month from atrial fibrillation onset. A subgroup of 33 patients with onset <
48 hours and low risk of stroke, were not anticoagulated; cardioversion was performed
before 48 hours from atrial fibrillation onset. All patients received brief general
anesthesia; the paddles were in anterior-posterior position. The initial shock was 200
Joules.
Results. Globally effective cardioversions were 196/221 (89%) - 32/33
(97%) in the subgroup with onset < 48h and 164/188 (87%) in patients with chronic
atrial fibrillation; the first shock was effective in 157/196 (80%) successful CV. Adverse
events were: asysthole > 3 seconds in 4 patients (2%), junctional rhythm or other
bradyarrhytmias in 9 patients (4%). There were no stroke, periferic embolism or adverse
events from anesthesia.
Conclusions. Electrical cardioversion in atrial fibrillation is
highly efficient in synus rhythm restoration, is also safe, easy to perform and without
major adverse events; in our experience 200 Joules seems to be the optimal starting
energy; risk stratification of stroke may avoid long-term anticoagulation and electrical
remodeling of atria in a subpopulation of patients with recent onset of atrial
fibrillation; in these patients electrical cardioversion has very high percentage of
success.
|
Key Words
|
|
Atrial fibrillation - transthoracic electrical
cardioversion
efficacy, optimal cardioversion energy, adverse events, risk stratification of stroke,
anticoagulation therapy, OA
|
