Alessandro Carunchio, Luciano Pandolfo, Maurizio Burattini, Claudio Coletta, Andrea Porzio, Maria Margherita Martinelli, Alessandro Danesi, Vincenzo Ceci.
Cardiology division, Santo Spirito Hospital, Rome, Italy
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AIM OF THE STUDY. Was to verify the safety and effectiveness
of a procedure for the treatment of patients (pts) with atrial fibrillation (AF) based on clinical and
echocardiographic data.
METHODS. A hundred and twenty-nine consecutive pts with AF were considered. According to Levy’s
classification, 16 had permanent AF and were excluded from the study. In 113 pts (mean age 67±11 years, M=65)
a cardioversion procedure (CV) was planned. Heparin treatment was started in all pts. Pts with>48 hours AF were
referred for transesophageal echo (TE); negative TE: CV was planned in the next 24 hours; positive TE: CV was
planned after 24 days to allow an effective warfarin treatment. Pts with<24 hours AF continued a total 24 hours
observation period before cardioversion. A pharmacological (propafenone or amiodarone; bolus+2 hours infusion)
approach to CV was primarily attempted. In case of failure, the pharmacological treatment was maintained and
synchronised DC shock (CV) was attempted (200, 300, 360 J). Based on clinical criteria, anti-arrhythmic medication
with amiodarone/sotalol/propafenone was planned in II-III class pts reverted to sinus rhythm. In case of relapse,
a second CV procedure was attempted. A>6 months follow-up (F-Up) was available in all pts (mean: 17±9 months).
RESULTS. Pts had 2±1.2 episodes of AF in their history, lone AF was present in 16/113 pts (14%). Mean left
atrial transverse diameter was: 41.2±4.9 mm. A class I, II a-b and III a-b AF was present in 28 (25%), 51 (45%) e 34
(30%) pts respectively. 106 pts (93.8%) reverted to sinus rhythm: spontaneous CV=15 pts (14%); pharmacological
CV=32 pts (30%); electrical CV=59 (56%). Embolic events without permanent lesions were recorded in 2 pts (1.8%);
minor adverse events (bradycardia, transient asystolia) occurred in 6 pts (5.7%). Follow-up informations were
available in 104/106 pts (98%). AF recurrences were observed in 33 pts out of 104 with CV effective (31.7%) of
which: 2/15 pts with spontaneous CV (13.3%), 9/32 with pharmacological CV (28%), 22/57 with electrical CV (38.6%);
This is an interesting trend but without statistical significant difference. In 14 pts (42%) AF recurred in the first 30
days after CV. The second CV procedure was successful in 27 pts (6 pts had third AF recurrence-CV not attempted).
At the end of F-Up period sinus rhythm was present in 94/111 pts (84.7%).
CONCLUSIONS. In pts with AF a CV procedure based on a stepwise clinical and echo-guided approach
allows a high rate of success and a low incidence of related adverse events.
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