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(Circulation. 1997;96:253-259.)
© 1997 American Heart Association, Inc.
Articles |
Low-Energy Cardioversion of Spontaneous Atrial Fibrillation
Immediate and Long-term Results
From the Cardiology Division, School of Medicine, University of Marseilles, Marseilles, France.
Correspondence to Samuel Lévy, MD, University of Marseilles, School of Medicine, Cardiology Division, Hôpital Nord, 13015 Marseilles, France.
Background 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.
Methods and Results Forty-two consecutive patients with
spontaneous AF underwent low-energy electrical cardioversion. AF was
chronic (
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
interindividual variation was noted.
Conclusions 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.
Key Words: arrhythmia • atrium • fibrillation • defibrillation • shock
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