Quadruple pads approach for external cardioversion of atrial fibrillation

Citation
Nf. Marrouche et al., Quadruple pads approach for external cardioversion of atrial fibrillation, PACE, 24(9), 2001, pp. 1321-1324
Citations number
23
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
ISSN journal
0147-8389 → ACNP
Volume
24
Issue
9
Year of publication
2001
Part
1
Pages
1321 - 1324
Database
ISI
SICI code
0147-8389(200109)24:9<1321:QPAFEC>2.0.ZU;2-B
Abstract
This study examined the alternative of transthoracic quadruple pads shock d elivery of two simultaneous 360-J shocks to convert refractory AF in patien ts failing standard external cardioversion. Forty-six patients (mean age 58 +/- 11 years, 23 men) with chronic AF (duration 14 +/- 17 months, range 1- 60 months) were included. The left atrial diameter was 47 +/- 7 mm. The lef t ventricular ejection fraction was 59 +/- 11%. Antiarrhythmic drugs had fa iled to convert 44 (96%) of these patients. All patients underwent conventi onal external transthoracic cardioversion with pads applied in the antero-a pical position using energy settings of 200 and 360 J, consecutively. In al l patients who failed conventional cardioversion, quadruple pads were appli ed, Quadruple pads consisted of four pads, two in the antero-posterior posi tion and two in a second apex-posterior position. Standard cardioversion to sin us rhythm was successful in 19 (41%) patients after use of a single 20 0-J shock and an additional 8 (17%) after a single 360-J shock. The total s uccess rate was 58% after conventional cardioversion. The quadruple pads we re successful in 14 (74%) of the remaining 19 patients. Four of the five pa tients who failed the quadruple pads approach subsequently also failed inte rnal cardioversion. Thus, the cardioversion success rate was increased from 48% using the conventional approach to 89% using the quadruple pads approa ch. Quadruple pads external cardioversion is highly effective in converting chronic AF refractory to standard shock protocols to sinus rhythm. Moreove r, the failure of the quadruple pads approach seems to predict poor respons e to internal cardioversion.