Direct current conversion of atrial fibrillation.

Long-Term Results of Conversion of Atrial Fibrillation by Direct Current Countershock

“…(5% compares favorably with that of other series [3,4,7,11,12,14]. The incidence of reversion to atrial fibrillation during the first 6 to 8 months is usually reported to be around 40 lo 50%.…”

Transoesophageal echocardiography for immediate and safe cardioversion in patients with atrial fibrillation

“…Of 1222 randomized patients, 619 were assigned to the transoesophageal echocardiography-guided arm, whereas 603 were assigned to the conventional arm. Atrial cavity and appendage thrombi were detected by transoesophageal echocardiography in 76 patients (14%) -a higher percentage than expected from previously reported data [6,7] and surprising in view of the previously reported much lower frequency of embolic events in patients not receiving anticoagulation therapy [13] . When thrombi were detected, a 3-week course of anticoagulation with warfarin was started, and consecutively, another transoesophageal echocardiography performed.…”

“…This suggests that transoesophageal echocardiography is not sensitive enough to detect atrial thrombi or delayed thrombus formation [10] . This lack of sensitivity, albeit minor, was confirmed by the outcome of the ACUTE multicentre trial [13] . One reason for this minor imperfection may be a certain inter-observer variability for left atrial and appendage thrombi as well as for left atrial spontaneous echo contrast [16] .…”

“…In addition, functional capacity at 8 weeks was similar in both groups: 27·4 18·3 vs 26·7 18·6; P=0·500. The long period of enrolment, the longer post-cardioversion follow-up in the transoesophageal echocardiography group compared to the conventional-treatment group, and the fact that the study was statistically underpowered must be considered limitations [13] . In conclusion, the transoesophageal echocardiography-guided strategy for cardioversion is as safe as the conventional one.…”

Use and Abuse of Direct Current Shock

“…First degree A-V block is often observed after correction of chronic atrial fibril lation or flutter. In this case, recurrence of the atrial fibrillation or flutter is very common and repeated cardioversion has little value [4,7,17,19].…”