medigraphic.com

2002, Number 2

<< Back Next >>

Arch Cardiol Mex 2002; 72 (2)

Internal cardioversion in chronic atrial fibrillation

Mendoza GC, Iturralde TP, Guevara VME, Nava TS, Rodríguez CL, Rodríguez BI

Language: Spanish
References: 31
Page: 138-144
PDF size: 300.35 Kb.


ABSTRACT

The importance of atrial fibrillation has always motivated the search of new treatment alternatives. Internal cardioversion has been proposed as a choice in the treatment of atrial fibrillation, giving rise to the development of atrial defibrillator. We present the case of a 68 years old patient without structural heart disease and with diagnosis of chronic atrial fibrillation of 10 months of evolution. He received treatment with antiarrhythmic drugs and successful electrical external cardioversion, but he relapsed a week later. For this reason, we decided to perform internal cardioversion with an electrocatheter (DAIG) placed in the coronary sinus through the right jugular vein and under light sedation with propofol (2 mg/kg weight). We applied three shocks of 1, 3, and 5 joules, being able to convert to sinus rhythm without complications. The patient continues under treatment with antiarrhythmic agents. Internal cardioversion has shown to be an effective way for the treatment of chronic atrial fibrillation, using a light sedation and low energy level to reestablish the sinus rhythm.


REFERENCES

  1. Psaty BM, Manolio TA, Kuller LH, Kronmel RA, Cushman M, Fried LP et al: Incidence of and risk factors for atrial Fibrillation in older adults. Circulation 1997; 96: 2455-2461.

  2. Peters KG, Kienzle MG: Severe Cardiomyopathy due to chronic rapidly conducted atrial fibrillation: complete recovery after restoration of sinus rhythm. Am J Med 1988; 85: 242-244.

  3. Daoud EG, Weiss R, Bahu M, Knight BP, Bogun F, Goyal R et al: Effect of an irregular ventricular rhythm on cardiac output. Am J CardioI 1996; 78: 1433-1436.

  4. Wijffels MC, Kirchhof CJ, Donald R, Allessie MA: Electrical remodeling due to atrial fibrillation in chronically instrumented conscious goats: roles of neurohumoral changes, ischemia, atrial stretch and high rate of electrical activation. Circulation 1997; 96: 3710-3720.

  5. Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA: Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92: 1954-1968.

  6. Franz MR, Karasik PL, Li C, Moubarak J, Chávez M: Electrical remodeling of the human atrium: similar effects in patients with chronic atrial fibrillation and atrial flutter. J Am Coll Cardiol 1997; 30: 1785-1792.

  7. Allessie MA, Lammers WJEP, Bonke FIM, Hollen J: Experimental evaluation of Moe’s multiple wavelet hypothesis of atrial fibrillation. En: Zipes DP, Jalife J, eds. Cardiac Electrophysiology and Arrhythmias. Nueva York:Grune & Stratton, 1985: 265-275.

  8. Davies MJ, Pomerance A: Pathology of atrial fibrillation in man. Br Heart J 1972;34:520-525.

  9. Prytowsky EN, Katz A: Atrial Fibrillation. En: Topol EJ, ed. Textbook of Cardiovascular Medicine. Philadelphia: Lippincott-Raven Publishers, 1998:1661-1693.

  10. Konings KT, Kirchhof CJ, Smeets JR, Wellens HJ, Penn OC, Allessie MA: High-density mapping of electrically induced atrial fibrillation in humans. Circulation 1994; 89: 1665-1680.

  11. Janse MJ: Mechanisms of Atrial Fibrillation. En: Zipes DP, Jalife J, eds. Cardiac Electrophysiology, From Cell to Bedside. 3a. Edition. Philadelphia, Pennsylvania. W.B. Saunders Company. 2000. 476-481.

  12. Bollman A: Quantification of electrical remodeling in human atrial fibrillation. Cardiovasc Res 2000; 47: 207-209.

  13. Jais P, Haisaguerre M, Shah DC, Chouairi S, Gencel L, Hocini M, et al: A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 1997; 95: 572-576.

  14. Haisaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al: Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Eng J Med 1998; 339: 659-666.

  15. Iturralde P, Medeiros A, Guevara M, Kershenovich S, Varela S, Colín L: Fibrilación auricular focal tratada mediante radiofrecuencia. Arch Inst Cardiol Mex 2000; 70: 173-179.

  16. Prytowsky EN: Management of atrial fibrillation: Therapeutic options and clinical decisions. Am J Cardiol 2000; 85: 3D-11D.

  17. Lown BR, Amarasinham R, Newman J: New method for terminating cardiac arrhythmias: use of synchronized capacity discharge. JAMA 1962; 182: 548-555.

  18. Van Gelder IC, Crijns HJGM: Cardioversion of atrial fibrillation and subsequent maintenance of sinus rhythm. PACE 1997; 20: 2675-2683.

  19. Alt E, Ammer R, Schmitt C, Evans F, Lehmann G, Pasquantonio J, et al: A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion. Eur Heart J 1997; 18: 1796-1804.

  20. Tse HF, Lau CP, Ayers GM: Long-term outcome in patients with chronic atrial fibrillation after successful internal cardioversion. Am J Cardiol 1999; 83: 607-609.

  21. Levy S, Lauribe P, Dolla E, Kau W, Kadish A, Calkins H et al: A randomized comparison of external and internal cardioversion of chronic atrial fibrillation. Circulation 1992; 86: 1415-1420.

  22. Levy S, Lacombe P, Cointe R, Bru P: High energy transcatheter cardioversion of chronic atrial fibrillation. JACC 1988; 12: 514-518.

  23. Cooper RAS, Alferness CA, Smith WM, Ideker RE: Internal cardioversion of atrial fibrillation in sheep. Circulation 1993; 87: 1673-1686.

  24. Lok N, Lau C, Tse H, Mayers G: Clinical shock tolerability and effect of different right atrial electrode locations on efficacy of low energy human transvenous atrial defibrillation using an implantable lead system. J Am Coll Cardiol 1997; 30: 1324-1330.

  25. Saliba W, Juratli N, Chung MK, Niebauer MJ, Erdogan O, Trohman R, et al: Higher energy synchronized external direct current cardioversion for refractory atrial fibrillation. J Am Coll Cardiol 1999; 34: 2031-2034.

  26. Karmelic C, Cambón A, González R: Cardioversión eléctrica interna con baja energía y curva bifásica en fibrilación auricular inducida durante el estudio electrofisiológico. Rev Esp Cardiol 2000; 53: 337-343.

  27. Alt E, Ammer R, Lehmann G, Ayers GM, Pasqantonio J, Schomig A: Patient characteristics and underlying heart disease as predictors of recurrent atrial fibrillation after internal and external cardioversion in patients treated with sotalol. Am Heart J 1997; 134: 419-425.

  28. Tse HF, Lau Cp, Yomtov BM, Ayers GM: Implantable atrial defibrillator with a single-pass dual-electrode lead. J Am Coll Cardiol 1999; 33: 1974-1980.

  29. Levy S, Richard P, Gueunoun M, Yapo F, Trigano J, Mansouri C, et al: Low-energy intracardiac cardioversion of spontaneous atrial fibrillation Immediate and long term results. Circulation 1997; 96: 253-259.

  30. Lie JT, Falk RH, James TN: Cardiac anatomy and pathologic correlates of atrial fibrillation. En: Falk AH, Podrid PJ, eds. Atrial Fibrillation: Mechanisms and Management. 2nd. ed. Philadelphia: Lippincott-Raven Publishers, 1997: 23-52.

  31. Mansourati J, Larlet JM, Salaun G, Maheu B, Blanc JJ: Safety of high energy internal cardioversion for atrial fibrillation. PACE 1997; 20: 1919-1923.




2020     |     www.medigraphic.com