Transesophageal electrical cardioversion of persistent atrial fibrillation: a new approach for an old technology

• Published in: Italian heart journal Vol. 3; no. 6; p. 354
• Main Authors: Zardo, Fabio, Brieda, Marco, Hrovatin, Enzo, Dametto, Ermanno, Cassin, Matteo, Sparacino, Lina, Cervesato, Eugenio, Nicolosi, Gian Luigi
• Format: Journal Article
• Language: English
• Published: Italy 01-06-2002
• Subjects: Aged; Analysis of Variance; Atrial Fibrillation - therapy; Catheterization; Chi-Square Distribution; Electric Countershock - instrumentation; Electric Countershock - methods; Female; Humans; Male; Middle Aged; Patient Satisfaction; Prospective Studies; Time Factors; Treatment Outcome
• ISSN: 1129-471X

Low energy intracardiac cardioversion may be considered the elective, alternative method for the acute restoration of sinus rhythm when direct current cardioversion fails or is contraindicated. Transesophageal cardioversion is a further alternative method for the recovery of sinus rhythm and obviates the potential complications of the low energy intracardiac cardioversion venous approach.
The present prospective study including 30 patients (21 males, 9 females, mean age 65.1 years, range 52-76 years), with persistent atrial fibrillation (mean duration 4.3 months), was undertaken in order to further evaluate, with regard to transesophageal cardioversion: 1) the acute efficacy, 2) the patient acceptance of the procedure, 3) the preferable choice among direct current cardioversion, low energy intracardiac cardioversion and transesophageal cardioversion, 4) the time required to perform the procedure, 5) the incidence of complications, and 6) the persistence of sinus rhythm after 1 month.
Sinus rhythm was acutely restored in 29 patients (96.7%). Discomfort induced by the electrical shock was minimal or mild in most patients (75.8%). Transesophageal cardioversion was usually preferred by patients who had been previously submitted to direct current cardioversion or low energy intracardiac cardioversion. The mean total time required to perform the procedure was 107.9 min. No complications related to the procedure occurred. In spite of adequate pharmacological prophylaxis of atrial fibrillation only 41.4% of patients were in sinus rhythm 1 month after successful transesophageal cardioversion.
Transesophageal cardioversion may be considered a very effective, well accepted and non-time consuming procedure for the short-term restoration of sinus rhythm. The incidence of complications is low.