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Disappointing success of electrical cardioversion for new-onset atrial fibrillation in cardiosurgical ICU patients


Arrigo, Mattia; Jaeger, Natalie; Seifert, Burkhardt; Spahn, Donat R; Bettex, Dominique; Rudiger, Alain (2015). Disappointing success of electrical cardioversion for new-onset atrial fibrillation in cardiosurgical ICU patients. Critical Care Medicine, 43(11):2354-2359.

Abstract

OBJECTIVES: To assess the success of electrical cardioversion for the treatment of new-onset atrial fibrillation in critically ill patients and to evaluate the stability of sinus rhythm in responders during the subsequent 24 hours.
DESIGN: Retrospective study.
SETTING: Twelve-bed cardiosurgical ICU at a university hospital.
PATIENTS: Seventy-two consecutive patients with postoperative new-onset atrial fibrillation (< 7 d of duration) treated by electrical cardioversion.
INTERVENTIONS: Electrical cardioversion using synchronized biphasic shocks.
MEASUREMENTS AND MAIN RESULTS: During 144 electrical cardioversions, 209 shocks were delivered to 72 patients. Maximal energy (200 J) was used in 85% of shocks. Electrical cardioversion immediately restored sinus rhythm in 102 sessions (71%). Pretreatment with amiodarone did not increase the success rates. During the follow-up, the percentages of sinus rhythm decreased from 43% after 1 hour to 23% after 24 hours. However, at ICU discharge, 54 patients (75%) were in sinus rhythm. Of the 54 patients in sinus rhythm, only 18 (33%) converted to sinus rhythm after repeated cardioversions, whereas the remaining 36 (66%) did so spontaneously or with amiodarone.
CONCLUSIONS: Biphasic electrical cardioversion in cardiosurgical ICU patients was immediately successful in restoring sinus rhythm in 71% of sessions. However, early relapse of atrial fibrillation was common in the 24-hour follow-up. At ICU discharge, the majority of patients were in sinus rhythm, but the efficacy of repetitive electrical cardioversion in restoring sinus rhythm was disappointing.

Abstract

OBJECTIVES: To assess the success of electrical cardioversion for the treatment of new-onset atrial fibrillation in critically ill patients and to evaluate the stability of sinus rhythm in responders during the subsequent 24 hours.
DESIGN: Retrospective study.
SETTING: Twelve-bed cardiosurgical ICU at a university hospital.
PATIENTS: Seventy-two consecutive patients with postoperative new-onset atrial fibrillation (< 7 d of duration) treated by electrical cardioversion.
INTERVENTIONS: Electrical cardioversion using synchronized biphasic shocks.
MEASUREMENTS AND MAIN RESULTS: During 144 electrical cardioversions, 209 shocks were delivered to 72 patients. Maximal energy (200 J) was used in 85% of shocks. Electrical cardioversion immediately restored sinus rhythm in 102 sessions (71%). Pretreatment with amiodarone did not increase the success rates. During the follow-up, the percentages of sinus rhythm decreased from 43% after 1 hour to 23% after 24 hours. However, at ICU discharge, 54 patients (75%) were in sinus rhythm. Of the 54 patients in sinus rhythm, only 18 (33%) converted to sinus rhythm after repeated cardioversions, whereas the remaining 36 (66%) did so spontaneously or with amiodarone.
CONCLUSIONS: Biphasic electrical cardioversion in cardiosurgical ICU patients was immediately successful in restoring sinus rhythm in 71% of sessions. However, early relapse of atrial fibrillation was common in the 24-hour follow-up. At ICU discharge, the majority of patients were in sinus rhythm, but the efficacy of repetitive electrical cardioversion in restoring sinus rhythm was disappointing.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:atrial fibrillation, cardiac surgery, critically ill, electrical cardioversion, intensive care unit
Language:English
Date:2015
Deposited On:30 Nov 2015 11:15
Last Modified:01 Dec 2016 01:00
Publisher:Lippincott Williams & Wilkins
ISSN:0090-3493
Publisher DOI:https://doi.org/10.1097/CCM.0000000000001257
PubMed ID:26468695

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