FIRST BIPHASIC SHOCK ENERGY FOR PERSISTENT ATRIAL FIBRILLATION CARDIOVERSION

PETTINATI G., PERRONE C., MARZO A., MUSCELLA A., DE SANTIS F.

Cardiology department –’’F: Ferrari’’ hospital  -Casarano -Italy

4th International MESPE Congress (Malaga 22 - 24 September 2005) Reprints from: Mediterranean Journal of Pacing and Electrophisyology. Volume n.7, 2005

Although biphasic shock appear to be superior to monophasic shock, only limited information is available on protocols and first shock energy for transthoracic cardioversion of persistent atrial fibrillation (AF)

 AIM OF THE STUDY

To evaluate a biphasic shock protocol based on escalating  energy in patient with persistent AF to identify the best first shock energy.

METHODS

•100 consecutive patients  ( 63 M, 37  F )

•Mean  age                          68 +  10  years

•Body  weight                     75 +   15 Kg

•A.F.  Mean  duration       2,5 +  2,2 months

The patients underwent an escalating 50-100-200 Joule shock protocol, delivered by a ZOLL  M series defibrillator

 •SINUS RHYTM MANTEINING – 1 HOUR

 •Etiology AF        hypertension     61 %

                                valvular             10%

                                ischemic            10%

                                dilatative card.   5% 

                                pulmonary h.d.   4%

                                idiopatic AF      10%         

RESULTS

Sinus rhythm cardioversion was achieved  in 94% of the cases :

            35 %  at 50 Joule

            88  %  at 100 Joule

            94% at 200 Joule.

 35 PATIENTS HAD RECIEVED   50 J

 53 PATIENTS                                50 J+ 100 J

 12 PATIENTS                                50 J+ 100 J+200 J

Mean  cumulative delivered energy was 145 + 51 Joule and the number of shocks to achieve cardioversion or complete the protocol was 1,8 + 0,8.  Factors related to unsuccessful cardioversion  were  body weigth above 80 Kg and atrial size above 4,8  cm

CONCLUSION

•TRANSTHORACIC BIPHASIC ELECTRICAL CARDIOVERSION OF  A.F. IS SAFE AND EFFICACIOUS.

•BASED ON OUR RESULTS, TO ACHIEVE SUCCESSFUL CARDIOVERSION OF PERSISTENT AF,THE OPTIMAL FIRST SHOCK ENERGY APPEAR TO BE 100  JOULE.