Skip to main content
Article thumbnail
Location of Repository

A review of direct current cardioversions for atrial arrhythmia.

By S. D. Johnston, T. G. Trouton and C. Wilson

Abstract

The risk of arterial embolism is well recognised following Direct Current Cardioversion (DCC) for atrial fibrillation although the use of prophylactic anticoagulation remains controversial. AIM: To determine the risk of arterial embolism post-cardioversion and which factors predict successful cardioversion and maintenance of sinus rhythm. MATERIALS AND METHODS: A retrospective study was carried out of all cardioversions performed for atrial fibrillation and atrial flutter at the Waveney Hospital Ballymena, during 1989-1993. A review of medical records and electrocardiograms was carried out to assess demographic characteristics, co-existent diseases, anticoagulant status, echocardiographic features and characteristics of the arrhythmia. Embolic events in the six weeks post-cardioversion were noted. RESULTS: The study included 157 cardioversions in 109 patients. The predominant arrhythmia was atrial fibrillation (n = 108, 69%). Three of 109 patients (2.7%) experienced embolic complications, none of whom had anticoagulation prior to the procedure. No risk factors for cerebro-vascular disease or significant valvular heart disease were present. Return to sinus rhythm was achieved in 143 (91%) procedures. Increasing coarseness of atrial fibrillation was associated with a non-significant trend towards successful restoration of sinus rhythm (p = 0.18). Recurrence of the original arrhythmia was predicted by an increase in coarseness of atrial fibrillation (p < 0.05). CONCLUSIONS: These findings indicate that embolic complications can occur in patients undergoing DCC with normal echocardiographic dimensions, and that prophylactic anticoagulation should be considered in all patients. Coarseness of atrial fibrillation may be used as a guide to predict the chance of successful cardioversion and of the likelihood of maintaining sinus rhythm once this has been achieved

Topics: Research Article
Publisher: Ulster Medical Society
OAI identifier: oai:pubmedcentral.nih.gov:2448669
Provided by: PubMed Central
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://www.pubmedcentral.nih.g... (external link)
  • Suggested articles

    Citations

    1. (1982). A L. Cardioversion of atrial fibrillation: consideration of embolization, anticoagulation,prophylacticpacemakerandlongterm success.
    2. (1990). Adgey A A J. Factors determining success and energy requirements for cardioversion ofatrial fibrillation. QJMed
    3. (1968). An evaluation of DC shock treatment of atrial arrhythmias. immediate results and complications in 437 patients, with longterm results in the first 290 ofthese. Acta Med Scand
    4. (1989). Antithrombotic therapy in atrial fibrillation. Chest
    5. (1988). Atrial fibrillation and stroke: newideas, persisting dilemmas. Stroke
    6. (1987). Atrialfibrillation: a major contributor to stroke in the elderly. The FraminghamStudy.ArchInternMed
    7. (1990). Cardioversion ofatrial fibrillation: a retrospective analysis ofthe safety and valueofanticoagulation. CardiovascRev &Rep
    8. (1990). ChalmersTC.Efficacyandsafetyofquinidinetherapy for maintenance of sinus rhythm after cardioversion. ameter-analysisrandomisedcontroltrials. Circulation
    9. (1993). Clinical competence in elective direct current(DC) cardioversion. astatement forphysicians from the ACP/ACC/AHA task force on clinical privileges in cardiology. JAm Coil Cardiol
    10. (1989). Echocardiographic and clinical predictors for outcome of elective cardioversionofatrialfibrillation.AmJCardiol
    11. (1966). Electrical conversion ofatrial fibrillation: immediate and longterm results and selection ofpatients. Ann Intern Med
    12. (1967). Electrical reversion of cardiac arrhythmias.
    13. (1982). Epidemiologico features of chronic atrial fibrillation: the Framingham Study.
    14. (1996). Management of patients with atrial fibrillation. a statement for healthcare professionals from the subcomittee on electrocardiography and electrophysiology, AmericanHeartAssociation. Circulation
    15. (1969). Orning 0 M. The efficacy of anticoagulant therapy inpreventing embolism related to D.C. electrical conversion ofatrial fibrillation.
    16. (1969). Prognosis of atrial arrhythmias treated by electrical counter shock therapy. a three-year follow-up. BrHeartJ
    17. (1989). Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation. JAm Coll Cardiol
    18. (1990). Return of atrial mechanical function following electrical conversion of atrial dysrhythmias.
    19. (1992). Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. JAm Coll Cardiol
    20. (1990). Should patients with atrial fibrillation be anticoagulated prior to and chronicallyfollowingcardioversion? Cardiovasc Clin
    21. (1988). Specific arrhythmias: diagnosis and treatment. In: Braunwald E,

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.