What question did this study set out to answer?

To define exact criteria for the safe and effective use of elective direct-current countershock in chronic atrial fibrillation.

November 2, 1964JAMA

Complications and Limitations of Direct-Current Countershock

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Why the study?

What are the efficacy and safety limitations of elective direct-current countershock in patients with chronic atrial fibrillation and other arrhythmias?

Population

65 patients with chronic atrial fibrillation, plus 3 patients with paroxysmal atrial tachycardia with block…

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

Member takes

Implication

DC countershock yields transient sinus rhythm restoration with poor maintenance and VF risk under digitalis; case reports leave open its net benefit in chronic AF.

Key Points

To define exact criteria for the safe and effective use of elective direct-current countershock in chronic atrial fibrillation.
Administered elective direct-current countershock to 65 patients with chronic atrial fibrillation (N=65).
Evaluated 35 patients with uncontrollable ventricular rates, heart failure, or disabling symptoms, and 30 patients following open heart surgery for mitral stenosis.
Sinus rhythm was initially restored in 88% (31/35) of medically indicated patients but maintained for two months in only 32% (10/31).
Conversion succeeded in 93% (28/30) of post-mitral stenosis surgery patients, but only 10% (3/30) remained in sinus rhythm for more than two weeks.
Fatal ventricular fibrillation occurred within 30 to 120 seconds post-shock in three patients, implicating digitalis intoxication as a severe potential hazard.

Structured PICO

What are the efficacy and safety limitations of elective direct-current countershock in patients with chronic atrial fibrillation and other arrhythmias?

Population

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

Intervention

Elective direct-current countershock

Outcome

Reestablishment and maintenance of sinus rhythmsafety

Direct-current countershock is highly effective at initially restoring sinus rhythm, but long-term maintenance is poor and it carries a risk of fatal ventricular fibrillation in the setting of digitalis intoxication.

Cite This Study

Rabbino et al. (1964) studied this question.

synapsesocial.com/papers/6a0934d1b7dd28a06e160ea2 https://doi.org/10.1001/jama.1964.03070180015003

Topics

Atrial fibrillation Persistent AF management Hypertension management Anticoagulation in AF AF ablation outcomes

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Implication

DC countershock yields transient sinus rhythm restoration with poor maintenance and VF risk under digitalis; case reports leave open its net benefit in chronic AF.

Complications and Limitations of Direct-Current Countershock

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Complications and Limitations of Direct-Current Countershock

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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