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Europace 2001 3(2):90-95; doi:10.1053/eupc.2001.0159
© 2001 by European Society of Cardiology
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REGULAR ARTICLES

Low-energy internal cardioversion in patients with long-lasting atrial fibrillation refractory to external electrical cardioversion: results and long-term follow-up

G. Gasparini, A. Bonso, S. Themistoclakis, F. Giada and A. Raviele

Division of Cardiology, Umberto I° Hospital Mestre, Venice, Italy

AIM: Low-energy internal cardioversion is a new electrical treatment for patients with persistent atrial fibrillation. This paper evaluates the efficacy and safety of low-energy internal cardioversion in patients with long-lasting atrial fibrillation refractory to external electrical cardioversion, and the clinical outcome of such patients.

METHOD AND RESULTS: The study population consisted of 55 patients [32 male, mean age 65±10 years, 48 (87%) with underlying heart disease] with long-lasting (mean 18±34 months) atrial fibrillation in whom external cardioversion had failed to restore sinus rhythm. Two custom-made catheters were used: one positioned in the right atrium and one in the coronary sinus or the left pulmonary artery. A standard catheter was inserted into the right ventricular apex to provide R wave synchronization. Sinus rhythm was restored in 52 patients (95%) with a mean defibrillating energy of 6.9±2.6 J (320±60 V). No complications were observed. During follow-up (mean 18±9 months), 16 patients (31%) suffered early recurrence (≤1 week) of atrial fibrillation and 20 patients (38%) had late recurrence (>1 week, mean 3.5±3.6 months) of atrial fibrillation. Six patients with a late recurrence again underwent cardioversion and five of these maintained sinus rhythm. Therefore, a total of 21/52 patients (40%) were in sinus rhythm at the end of follow-up. No clinical difference was found between patients with and without recurrences.

CONCLUSIONS: Low-energy internal cardioversion is a useful means of restoring sinus rhythm in patients with long-lasting atrial fibrillation refractory to external electrical cardioversion. More than one-third of patients maintained sinus rhythm during long-term follow-up.

Key Words: Atrial fibrillation, low-energy internal cardioversion, external cardioversion, atrial defibrillation, clinical outcome

Correspondence: Dr Gianni Gasparini, Division of Cardiology, Umberto I° Hospital, Via Circonvallazione 50, 30174, Mestre, Venice, Italy. E-mail: cardio.mestre{at}tin.it


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