Cardioversion of atrial fibrillation and subsequent maintenance of sinus rhythm

I.C. van Gelder*, H.J.G.M. Crijns

*Corresponding author for this work

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    51 Citations (Scopus)

    Abstract

    This article gives an overview of electrical cardioversion of AF and includes the discussion of newer strategies. DC external cardioversion is highly effective and carries a low risk of complications. Other approaches, like transesophageal cardioversion and high energy internal cardioversion, may improve the acute success rate but do not enhance long-term maintenance of sinus rhythm compared to external cardioversion. An atrial defibrillator may have important advantages which relate to the fact that the duration and possibly also the number of AF episodes become reduced. Supposedly, shortening the attacks of AF may exert an antiarrhythmic effect by limiting electrical, anatomical, and neurohumoral remodeling. So far, low energy biatrial defibrillation using an atrial defibrillator seems to be effective and safe (i.e., does not induce ventricular arrhythmias). However, discomfort limits its tolerability in clinical practice. Future improvement of leads and light sedation that is easy to administer may overcame this problem. In the second part of this overview, the probability of AF recurrence using a serial cardioversion approach is discussed. In middle-aged patients with a fair exercise tolerance and an arrhythmia duration <than 36 months this approach may be worthwhile. Young patients (age <57 years) with an arrhythmia duration <3 months and without hypertension may be cured from the arrhythmia with a single shock and without the institution of antiarrhythmic drugs. However, the serial electrical cardioversion approach is unlikely to succeed in elderly patients with a duration of AF exceeding 36 months and a poor exercise tolerance (NYHA Functional Class III or IV).

    Original languageEnglish
    Pages (from-to)2675-2683
    Number of pages9
    JournalPace-Pacing and Clinical Electrophysiology
    Volume20
    Issue number10
    DOIs
    Publication statusPublished - Oct-1997
    EventIVth Interlaken Symposium on Arrhythmia Risk Stratification - , Switzerland
    Duration: 1-Feb-1997 → …

    Keywords

    • atrial fibrillation
    • cardioversion
    • atrial defibrillator
    • electrical remodeling
    • heart failure
    • LOW-ENERGY CARDIOVERSION
    • ELECTRICAL CARDIOVERSION
    • INTERNAL CARDIOVERSION
    • ANTIARRHYTHMIC DRUGS
    • FLECAINIDE ACETATE
    • QUINIDINE THERAPY
    • ACUTE CONVERSION
    • TIME-COURSE
    • FLUTTER
    • EFFICACY

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