Header

UZH-Logo

Maintenance Infos

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.

Statistics

Citations

Dimensions.ai Metrics
10 citations in Web of Science®
11 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

75 downloads since deposited on 30 Nov 2015
42 downloads since 12 months
Detailed statistics

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:14 Feb 2018 09:56
Publisher:Lippincott Williams & Wilkins
ISSN:0090-3493
OA Status:Green
Publisher DOI:https://doi.org/10.1097/CCM.0000000000001257
PubMed ID:26468695

Download

Download PDF  'Disappointing success of electrical cardioversion for new-onset atrial fibrillation in cardiosurgical ICU patients'.
Preview
Content: Published Version
Filetype: PDF
Size: 545kB
View at publisher