RT-187
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Low energy endocavitary
cardioversion: safety, effectiveness and tolerability
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Claudio Pandozi, Giuseppe
Gentilucci, Massimo Santini.
Department of Cardiology, S. Filippo Neri Hospital, Rome, Italy
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Abstract
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Low energy intraatrial defibrillation is a new
therapeutic option to restore sinus rhythm in patients with atrial fibrillation. The
success rate of the procedure is very high, when the right atrium-coronary sinus or the
right atrium-left pulmonary artery configurations are used, with the right atrium-coronary
sinus vector associated to a little higher atrial defibrillation threshold. Nevertheless,
there are still some issues concerning the safety and tolerability of the procedure. Low
energy intraatrial cardioversion, in our and other authors' experience, is safe, even
during exercise, provided that the shock is well synchronized and the pre-shock RR
interval sufficiently long (> 500 ms). For what concerns the tolerability, the
procedure is related to some degree of discomfort, because the atrial defibrillation
threshold, in patients with persistent atrial fibrillation, ranges, in the different
series, from 4 to 8 J. Anyway, the tolerability can be improved utilizing different shock
waveforms, using a "single shock approach" and pretreating the patient with
antiarrhythmic drugs which lowers the atrial defibrillation threshold. With these
considerations in mind, low energy intraatrial cardioversion can be considered as the
treatment of first choice in patients with paroxysmal or persistent atrial fibrillation
resistant to external cardioversion and in patients in whom general anesthesia is
contraindicated, hazardous or refused. In our opinion, the procedure could be enlarged to
patients affected by obesity or lung diseases in whom the efficacy of external
cardioversion is notoriously low.
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Key Words
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Atrial fibrillation – transvenous internal
cardioversion
low energy atrial cardioversion, right atrium-coronary sinus configuration, right
atrium-left pulmonary artery configuration, atrial defibrillation threshold, pain
torelability, safety, efficacy, pharmacologic pre-treatment, biphasic shock, indications,
OA
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