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Researchers began this study with high hopes that electrical cardioversion (ECV) would be a beneficial part of the treatment plan for critically ill postoperative patients with new-onset atrial fibrillation. They also sought to evaluate the stability of sinus rhythm in responders for a 24-hour interval after initial treatment. Seventy-two intensive care unit (ICU) patients with newonset atrial fibrillation who had undergone cardiac surgery were studied. One hundred forty-four ECVs, for a total of 209 shocks, were delivered to the test subjects. Maximal energy at 200 J was used in 85% of individual shocks. Results were something of a double-edged sword. Electrical cardioversion immediately restored sinus rhythm in 71% of the sessions. Follow-up evaluations, however, at 1 and 24 hours yielded sustained success rates of 48% and 23%, respectively. Upon discharge from the ICU, 54 of the cohort of 72 were in sinus rhythm. Of those, only 18 converted to sinus rhythm after repeated cardioversions. The remainder did so spontaneously or with amiodarone. Researchers reported that, despite the immediate success of cardioversion in cardiosurgical ICU patients, results that showed early relapse rate within the 24-hour time frame and the poor efficacy of repetitive ECV in restoring sinus rhythm were disappointing.

DISAPPOINTING SUCCESS OF ELECTRICAL CARDIOVERSION FOR NEW-ONSET ATRIAL FIBRILLATION IN CARDIOSURGICAL ICU PATIENTS