Low efficacy of cardioversion of persistent atrial fibrillation with the implantable cardioverter-defibrillator

Abstract

AimsAtrial fibrillation (AF) and heart failure are conditions that often coexist. Consequently, many patients with an implantable cardioverter-defibrillator (ICD) present with AF. We evaluated the effectiveness of internal cardioversion of AF in patients with an ICD.MethodsRetrospectively, we included 27 consecutive ICD patients with persistent AF who underwent internal cardioversion using the ICD. When ICD cardioversion failed, external cardioversion was performed.ResultsPatients were predominantly male (89 %) with a mean (SD) age of 65 ± 9 years and left ventricular ejection fraction of 36 ± 17 %. Only nine (33 %) patients had successful internal cardioversion after one, two or three shocks. The remaining 18 patients underwent external cardioversion after they failed internal cardioversion, which resulted in sinus rhythm in all. A smaller left atrial volume (99 ± 36 ml vs. 146 ± 44 ml; p = 0.019), a longer right atrial cycle length (227 (186–255) vs. 169 (152–183) ms, p = 0.030), a shorter total AF history (2 (0–17) months vs. 40 (5–75) months, p = 0.025) and dual-coil ICD shock (75 % vs. 26 %, p = 0.093) were associated with successful ICD cardioversion.ConclusionInternal cardioversion of AF in ICD patients has a low success rate but may be attempted in those with small atria, a long right atrial fibrillatory cycle length and a short total AF history, especially when a dual-coil ICD is present. Otherwise, it seems reasonable to prefer external over internal cardioversion when it comes to termination of persistent AF.

Impact of internal and external electrical cardioversion on cardiac specific enzymes and inflammation in patients with atrial fibrillation and heart failure

“…Therefore, the interpretation of these data should be considered very carefully. From the perspective of success rate of internal and external CV in AF patients with HF, our findings support an earlier study of Limantoro and colleagues [16]. They reported a success rate of 33% after one, two, or three shocks.…”

Concurrent Cardioversion of Atrial Fibrillation during ICD Shock Testing

“…There has been only one study to date examining internal cardioversion of AF using ICDs. 28 Limantoro et al examined retrospectively 27 patients with internal cardioversion of persistent AF using ICD-devices, and reported a success rate of 33% compared to 77% in our patients. This rate seems surprisingly low at first sight, as the aim of their study was to cardiovert AF, yet can be explained by use of single-coil leads in most patients.…”

“…There has been only one study to date examining internal cardioversion of AF using ICDs . Limantoro et al.…”

Cardioversion in Non-Valvular Atrial Fibrillation

“…In patients with atrial fibrillation and implantable cardioverter-defibrillator (ICD), the ICD can be used for internal cardioversion. However, with approximately 30% the success rate is lower than with external cardioversion (37).…”