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European Heart Journal 2000 21(10):848-855; doi:10.1053/euhj.1999.1870
Copyright © 2000 by the European Society of Cardiology.
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Transoesophageal low-energy cardioversion of atrial fibrillation. Results with the oesophageal–right atrial lead configuration

M. Santini, C. Pandozif1, F. Colivicchi, F. Ammirati, M. Carmela Scianaro, A. Castro, F. Lamberti and G. Gentilucci

Department of Cardiology, San Filippo Neri Hospital, Rome, Italy

revised July 30, 1999; accepted August 4, 1999

Abstract

Background Low energy internal cardioversion is a safe and effective procedure to restore sinus rhythm in patients with atrial fibrillation refractory to external cardioversion. However the procedure is invasive and fluoroscopy is mandatory.

Aim of the study To assess the efficacy, safety and tolerability of a new simplified procedure of low energy internal cardioversion.

Methods Twenty-five consecutive patients (19 males and 6 females) with persistent atrial fibrillation were submitted to low energy internal cardioversion using a step-up protocol (in steps of 50V, starting from 300V). A large surface area lead (cathode) was positioned in the oesophagus, 45cm from the nasal orifice. A second large surface area lead (anode) was positioned in the right atrium. A quadripolar lead was positioned at the right ventricular apex to achieve ventricular synchronization and back-up pacing. Oesophageal endoscopy was performed within 24h of the end of the procedure and repeated after 48h, if injury to the oesophageal mucosa had occurred.

Results Sinus rhythm was restored in 23 patients (92%) with a mean delivered energy of 15·74J (range 5–27) and a mean impedance of 48{Omega}. In two patients, endoscopy revealed that small burns had occurred in the oesophageal mucosa. Such lesions spontaneously healed after 48h.

Conclusions This new technique of performing low energy internal cardioversion is effective and safe and avoids the positioning of a lead in the coronary sinus or in the left pulmonary artery, thereby simplifying the procedure.

Key Words: Atrial fibrillation, cardioversion, oesophageal cardioversion, endocavitary cardioversion

f1 Correspondence: Claudio Pandozi, MD, via Madonna di Fatima, 22, 00147 Rome, Italy.

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