14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-99

Bidirectional transoesophageal cardioversion in patients after CABG in acute postoperative period

Krzysztof Poleszak, El˙zbieta Krawczyk*, Andrzej Kutarski, Janusz Sta˙zka*.
Dept. of Cardiology, *Dept. of Cardiosurgery, University Medical Academy, Lublin, Poland

Abstract

Atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery; its incidence ranges from 5% up to 40%. Electric cardioversion is the treatment of choice in unstable patients but the shock-induced damage of myocardium still has not been excluded, so repetitive transchest cardioversion (TC) with high energy remains doubtful. During the classical TC only a small amount of energy reaches atria but during bidirectional trans-oesophageal cardioversion (BTC) energy is concentrated there. In 24 pts after CABG, 1 after left pulmonectomy and 1 after left lobectomy during acute postoperative period BTC was performed. The results were compared with obtained in other (not postoperative) patients. Shocks 8, 12, 20, 30, 40, 50 and 100 J were delivered between the 4-ring oesophageal electrode (active area 11 cm2) and two connected with each other, standard chest pads, positioned in V1 and V2 ECG region. The application of second chest electrode seems to make current flow through the atria more effective.

In 2 of 22 successfully cardioverted pts AF/AFL recovered after 1 min, in 3 after 2 hours and in 2 after 2 days. In pts after pulmonectomy and lobectomy previous TC was unsuccessful but BTC reverted pts to sinus rhythm. No complications or significant complains were noted.

CONCLUSIONS. 1) BTC is the effective and safe method for reverting sinus rhythm in patients treated in postoperative ICU. 2) BTC enables a significant reduction of shock energy; it seems to be particularly useful in postoperative patients. 3) Postoperative patients can be safely cardioverted using BTC, even at the short intervals.

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