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Abstract
The aim of this study was to evaluate the new method of low-energy, catheter-based
intracardiac cardioversion in patients with chronic atrial fibrillation (AF) and to
compare 2 different lead positions. Accordingly, we prospectively studied 80 consecutive
patients with chronic AF (9.8 ± 7.9 months) who were randomly assigned to undergo
internal cardioversion either via defibrillation electrodes placed in the right atrium
and coronary sinus (coronary sinus group) or via defibrillation electrodes placed
in the right atrium and left pulmonary artery (pulmonary artery group). Intracardiac
shocks were delivered by an external defibrillator synchronized to the QRS complex.
After conversion, all patients were treated orally with sotalol (mean daily dose,
189 ± 63 mg/day). For conversion to sinus rhythm, the overall mean energy requirement
was 5.6 ± 3.1 J. In the coronary sinus group, cardioversion was achieved in 35 of
38 patients at a mean energy level of 4.1 ± 2.3 J (range 1.0 to 9.9), and in the pulmonary
artery group in 39 of 42 patients with 7.2 ± 3.1 J (range 2.5 to 14.8). Although there
was no difference with regard to success rate, the energy differed significantly between
the 2 groups (p < 0.01). Mean lead impedance was 56.4 ± 7.0 Ω and 54.6 ± 8.4 Ω, respectively
(p = NS). No serious complications were observed in either lead group. At a mean followup
of 14.2 ± 7.0 months, 54% and 56%, respectively, of patients who had been converted
successfully remained in sinus rhythm. Thus, low-energy biphasic shocks delivered
between the right atrium and coronary sinus or pulmonary artery are equally effective
for cardioversion of patients with chronic AF. The energy requirements for conversion
from a pulmonary artery electrode position are higher than for the coronary sinus
position.
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Article info
Publication history
Accepted:
September 17,
1996
Received:
July 16,
1996
Identification
Copyright
© 1997 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc. All rights reserved.
