| Initial energy setting, outcome and efficiency in direct current cardioversion of atrial fibrillation and flutter. | |
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MedLine Citation:
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PMID: 11691530 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The purpose of this study was to design a more efficient protocol for the electrical cardioversion of atrial arrhythmias. BACKGROUND: Guidelines for electrical cardioversion of atrial arrhythmias recommend starting with low energy shocks, which are often ineffective. METHODS: We recorded the sequence of shocks in 1,838 attempts at cardioversion for atrial fibrillation (AF) and 678 attempts at cardioversion for atrial flutter. These data were used to calculate the probability of success for each shock of a standard series and the probability of success with a single shock at each intensity. In 150 cases, a rhythm strip with the time of each shock allowed us to calculate the time expended on unsuccessful shocks. RESULTS: We analyzed the effects of 5,152 shocks delivered to patients for AF and 1,238 shocks delivered to patients for atrial flutter. The probability of success on the first shock in AF of > 30 days duration was 5.5% at < 200 J, 35% at 200 J and 56% at 360 J. In atrial flutter, an initial 100 J shock worked in 68%. In AF of >30 days duration, shocks of < 200 J had a 6.1% probability of success; this fell to 2.2% with a duration >180 days. In those with AF for >180 days, the initial use of a 360 J shock was associated with the eventual use of less electrical energy than with an initial shock of < or =100 J (581 +/- 316 J vs. 758 +/- 433 J, p < 0.01, Mann-Whitney U test). CONCLUSIONS: An initial energy setting of > or =360 J can achieve cardioversion of AF more efficiently in patients than traditional protocols, particularly with AF of longer duration. |
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Authors:
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M M Gallagher; X H Guo; J D Poloniecki; Y Guan Yap; D Ward; A J Camm |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 38 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2001 Nov |
Date Detail:
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Created Date: 2001-11-05 Completed Date: 2001-12-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1498-504 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom. mm.gallagher@virgin.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Analysis of Variance Atrial Fibrillation / diagnosis, etiology, therapy* Atrial Flutter / diagnosis, etiology, therapy* Chronic Disease Clinical Protocols / standards Efficiency Electric Countershock / adverse effects, instrumentation, methods*, standards* Electricity* / adverse effects Electrocardiography Humans Least-Squares Analysis Life Tables Predictive Value of Tests Retrospective Studies Safety Statistics, Nonparametric Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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