What question did this study set out to answer?

To establish precise criteria for the safe application and identify the limitations and complications of direct-current countershock in chronic atrial fibrillation.

May 1, 1965Journal of Occupational and Environmental Medicine

Complications and Limitations of Direct-Current Countershock

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Why the study?

Does elective direct-current countershock safely restore and maintain sinus rhythm in patients with chronic atrial fibrillation?

Population

65 patients with chronic atrial fibrillation, plus 3 patients with other arrhythmias.

Design

Case_series

Follow-up

Up to 2 months

Authors

MRMichael D. RabbinoHahnemann University Hospital WLWilliam LikoffPhiladelphia University LDLeonard S. DreifusAmerican College of Cardiology

Discussion

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Implication

Urges digitalis assessment before elective DC cardioversion in AF; leaves open long-term maintenance with contemporary therapies.

Key Points

To establish precise criteria for the safe application and identify the limitations and complications of direct-current countershock in chronic atrial fibrillation.
Elective direct-current countershock was evaluated in 65 patients with chronic atrial fibrillation (N=65).
Patients were categorized into Group 1 (n=35) with refractory symptoms or heart failure, and Group 2 (n=30) undergoing conversion following open-heart surgery for mitral stenosis.
Immediate sinus rhythm reestablishment occurred in 88% (31/35) of Group 1, but was maintained for two months in only 32% (10/31).
Postoperative conversion succeeded in 93% (28/30) of Group 2, but only 10% (3/30) remained in sinus rhythm beyond two weeks.
Fatal ventricular fibrillation occurred within 30 to 120 seconds post-shock in 3 patients with complex tachycardias, indicating digitalis intoxication as a critical hazard.

Structured PICO

Does elective direct-current countershock safely restore and maintain sinus rhythm in patients with chronic atrial fibrillation?

Population

65 patients with chronic atrial fibrillation (35 with uncontrollable ventricular rate, persistent congestive heart failure, or disabling awareness; 30 following open heart surgery for mitral stenosis), plus 3 patients with other arrhythmias (paroxysmal atrial tachycardia with block, intermittent ventricular tachycardia).

Intervention

Elective direct-current countershock

Outcome

Reestablishment and maintenance of sinus rhythmsafety

Direct-current countershock is highly effective for initial conversion of atrial fibrillation but has low long-term maintenance rates and carries a severe risk of fatal ventricular fibrillation in the setting of digitalis intoxication.

Cite This Study

Rabbino et al. (1965) studied this question.

synapsesocial.com/papers/6a0934d1b7dd28a06e160ea0 https://doi.org/10.1097/00043764-196505000-00059

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Complications and Limitations of Direct-Current Countershock

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Complications and Limitations of Direct-Current Countershock

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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