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Reversion and Maintenance of Sinus Rhythm in Patients with Permanent Atrial Fibrillation by Internal Cardioversion Followed by Biatrial Pacing
Author(s) -
FRAGAKIS NIKOLAOS,
SHAKESPEARE CARL F.,
LLOYD GUY,
SIMON RON,
BOSTOCK JULIAN,
HOLT PHYLLIS,
GILL JASWINDER S.
Publication year - 2002
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.1460-9592.2002.00278.x
Subject(s) - medicine , cardioversion , atrial fibrillation , cardiology , sinus rhythm , coronary sinus , population , amiodarone , anesthesia , environmental health
FRAGAKIS, N., et al. : Reversion and Maintenance of Sinus Rhythm in Patients with Permanent Atrial Fibrillation by Internal Cardioversion Followed by Biatrial Pacing. Patients in atrial fibrillation (AF) who fail external cardioversion are usually regarded as in permanent AF. Internal cardioversion may revert many such patients into sinus rhythm (SR) but the majority relapse rapidly into AF. We investigated whether internal cardioversion followed by biatrial pacing is an effective to restore and subsequently maintain SR in patients with permanent AF. Patients in permanent AF underwent internal cardioversion that was followed by biatrial temporary pacing for 48 hours. Those who remained in SR received a permanent biatrial pacemaker programmed to a rate responsive mode with a lower rate 90 beats/min. Primary end point of the study included maintenance in SR 3 months after internal cardioversion. Sixteen patients ( 14 men, 57 ± 11 years ) were cardioverted. The median duration of AF was 24 months ( quartiles, Q 1 = 8.5 and Q 3 = 102 ) and mean left atrium diameter was 48 ± 04 mm. A permanent biatrial pacemaker was implanted in 11 patients. At a mean follow‐up of 15 months (range 4 to 24), 8 patients remained in SR for more than 3 months. AF was eliminated in 5 patients, while in two a second internal cardioversion on amiodarone was required. Antiarrhythmic therapy was used in half of our population and did not predict the long‐term maintenance of SR. Following internal cardioversion with continuous biatrial pacing, 50% of patients with permanent AF were maintained for prolonged periods in SR. This is a new modality of treatment of permanent AF directed to the maintenance of SR that provides a further therapeutic option in end‐stage AF.