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Netherlands Heart Journal

, Volume 21, Issue 12, pp 548–553

First Online: 04 October 2013

Abstract

AimsAtrial fibrillation AF and heart failure are conditions that often coexist. Consequently, many patients with an implantable cardioverter-defibrillator ICD present with AF. We evaluated the effectiveness of internal cardioversion of AF in patients with an ICD.

MethodsRetrospectively, we included 27 consecutive ICD patients with persistent AF who underwent internal cardioversion using the ICD. When ICD cardioversion failed, external cardioversion was performed.

ResultsPatients were predominantly male 89 % with a mean SD age of 65 ± 9 years and left ventricular ejection fraction of 36 ± 17 %. Only nine 33 % patients had successful internal cardioversion after one, two or three shocks. The remaining 18 patients underwent external cardioversion after they failed internal cardioversion, which resulted in sinus rhythm in all. A smaller left atrial volume 99 ± 36 ml vs. 146 ± 44 ml; p = 0.019, a longer right atrial cycle length 227 186–255 vs. 169 152–183 ms, p = 0.030, a shorter total AF history 2 0–17 months vs. 40 5–75 months, p = 0.025 and dual-coil ICD shock 75 % vs. 26 %, p = 0.093 were associated with successful ICD cardioversion.

ConclusionInternal cardioversion of AF in ICD patients has a low success rate but may be attempted in those with small atria, a long right atrial fibrillatory cycle length and a short total AF history, especially when a dual-coil ICD is present. Otherwise, it seems reasonable to prefer external over internal cardioversion when it comes to termination of persistent AF.

KeywordsAtrial fibrillation Implantable cardioverter defibrillator Internal cardioversion The questions can be answered after the article has been published in print. You have to log in to: www.cvoi.nl.

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Autor: I. Limantoro - K. Vernooy - B. Weijs - R. Pisters - L. Debie - H. J. Crijns - Y. Blaauw

Fuente: https://link.springer.com/



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