Premium
Internal Low Energy Cardioversion of Atrial Fibrillation Using a Single Lead System: Comparison of a Left and Right Pulmonary Artery Catheter Approach
Author(s) -
SCHMIEDER SEBASTIAN,
SCHNEIDER MICHAEL A. E.,
KARCH MARTIN R.,
SCHMITT CLAUS
Publication year - 2001
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2001.01108.x
Subject(s) - medicine , cardioversion , cardiology , sinus rhythm , atrial fibrillation , catheter , coronary sinus , anesthesia , surgery
SCHMIEDER, S., et al. : Internal Low Energy Cardioversion of Atrial Fibrillation Using a Single Lead System: Comparison of a Left and Right Pulmonary Artery Catheter Approach. Internal cardioversion (ICV) has been demonstrated as an effective and safe method for restoring sinus rhythm in patients with AF. Recently, a new single lead system with a balloon‐guided cardioversion catheter was introduced. ICV was performed after advancing a 7.5 Fr catheter flow‐directed into the left or right pulmonary artery (PA, distal array, cathode). The proximal array (anode) was placed at the lateral RA wall. Synchronized shocks (3/3 ms biphasic impulse) were applied using a stepwise protocol (0.5, 3, 6, 9, 12, 15 J) until sinus rhythm was restored or maximum energy (15 J) was reached. Sixty‐five patients (mean age 58 ± 13 years) with acute and chronic AF were included. Sinus rhythm could be restored in 59 (91%) patients. Cardioversion success was 93% in the left PA compared to 86% in right PA. DFTs for the left and right PA approaches were 7.1 ± 4.0 J and 10.2 ± 4.0 J, respectively ( P < 0.0001 ). It was significantly higher in patients with an AF history > 7 days ( 7.2 ± 4.1 J) than for those with a recent onset of AF ( 5.6 ± 4.1 J), P = 0.0012 . Shock impedance differed for the left and right PA lead configuration ( 53 ± 11 vs 49 ± 13 Ω, P < 0.05 ). A right PA lead configuration is as effective compared to a left PA catheter approach when performing ICV for AF. ICV with a single lead system is safe and cardioversion success is comparable to other internal and external cardioversion techniques. In combination with hemodynamic monitoring, flow‐directed nonfluoroscopic catheter positioning is feasible and may serve as a valuable therapeutic and diagnostic tool in intensive care units.