BACKGROUND: Low-energy internal atrial cardioversion is a relatively new technique based on delivery of intracardiac shocks through transvenous catheters placed into the atria or the vessels. OBJECTIVE: The aim of this study was to assess in older and younger patients with chronic persistent atrial fibrillation (AF) the efficacy and safety of transvenous low-energy internal atrial cardioversion performed without routine administration of sedatives or anesthetics. DESIGN: A prospective longitudinal study. SETTING: A cardiological university hospital. PARTICIPANTS: 82 patients, divided into older (greater than or equal to 60 years) (n = 49) and younger (n = 33) subjects. MEASUREMENTS: Atrial defibrillation threshold for internal cardioversion, measured as leading edge voltage (V) and delivered energy (J) of effective shocks, percentage of patients maintaining sinus rhythm at short-term (within 3 days) and at long-term follow-up. METHODS: Patients with chronic persistent AF, treated with oral anticoagulants for at least 3 to 4 weeks, were admitted to hospital. Following a clinical work-up, patients were subjected to low-energy internal atrial cardioversion with shock delivery according to a step-up protocol. RESULTS: Internal cardioversion was effective in restoring sinus rhythm in 90% (44/49) of the older patients and in 94% (31/33) of the younger patients. Shocks were effective at a mean energy between 6 and 8 joules (range 0.9-23) and administration of sedatives or anesthetics was required during the procedure in 22% (11/49) of older and in 48% (16/33) of younger patients (P = .026 at chi-square). No major complications occurred during the procedure. Pharmacological prophylaxis of AF recurrences was instituted immediately following the procedure. During inhospital stay and during the follow-up (mean 12 +/- 9 months for older patients and 15 +/- 10 months for younger patients), AF recurred in 39% (17/44) of older patients and in 16%, (5/31) of younger subjects (P = .064 at chi-square). CONCLUSIONS: Internal low energy cardioversion is a very effective procedure For restoring sinus rhythm in patients with AF; it can be performed in older patients, and administration of sedatives or anesthetics can be avoided or minimized in a substantial proportion of subjects. Recurrences of AF in the long term tend to be higher in older subjects and intensive prophylaxis with antiarrhythmic drugs is required.
|Data di pubblicazione:||2001|
|Titolo:||Internal low energy atrial cardioversion: Efficacy and safety in older patients with chronic persistent atrial fibrillation|
|Autore/i:||Boriani, Giuseppe; Biffi, M; Magagnoli, G; Zannoli, R; Branzi, A.|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1046/j.1532-5415.2001.49014.x|
|Codice identificativo ISI:||WOS:000168067300013|
|Codice identificativo Scopus:||2-s2.0-0035123220|
|Codice identificativo Pubmed:||11207847|
|Citazione:||Internal low energy atrial cardioversion: Efficacy and safety in older patients with chronic persistent atrial fibrillation / Boriani, Giuseppe; Biffi, M; Magagnoli, G; Zannoli, R; Branzi, A.. - In: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY. - ISSN 0002-8614. - 49:1(2001), pp. 80-84.|
|Tipologia||Articolo su rivista|
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