Key result
Low-energy internal cardioversion and transthoracic cardioversion resulted in similar rates of sinus rhythm maintenance at 18 months (23% vs 38%, P>0.05) in persistent atrial fibrillation.
Why the study?
Does low-energy internal cardioversion improve the long-term maintenance of sinus rhythm compared to transthoracic cardioversion in patients with persistent atrial fibrillation?
RCT (n=52)
Open-label
Randomly assigned
No
Does low-energy internal cardioversion improve the long-term maintenance of sinus rhythm compared to transthoracic cardioversion in patients with persistent atrial fibrillation?
Low-energy internal cardioversion does not provide a significant long-term advantage over standard transthoracic cardioversion for maintaining sinus rhythm in patients with persistent atrial fibrillation.
Transthoracic cardioversion remains first-line for persistent AF; confirms no long-term advantage of internal approach.
Low energy internal cardioversion (ICV) is a relatively new method. This report describes the long-term follow-up results of a prospective randomized comparison of low energy ICV and transthoracic cardioversion (TT CV) in patients with persistent atrial fibrillation (AF). Fifty-two patients (mean age, 60.6 +/- 10.1 years, 23 males) with persistent AF were randomly assigned to either TT (n = 26) or ICV (n = 26). The baseline characteristics of the 2 groups were similar. Transthoracic CV was performed under sedation with hand-held electrodes in the apex-anterior position and high energy (100-360 J) monophasic shocks. ICV was performed by a dedicated balloon-directed catheter utilizing truncated, biphasic shocks of low energy (1-15 J). Sinus rhythm (SR) was restored in 24/26 (92%) patients in the ICV group and in 22/26 (85%) patients in the TT CV group (P > 0.05). Immediate recurrence of AF (IRAF), defined as reappearance of AF within 2 minutes of successful CV, occurred in 5 patients (21%) in the ICV group and in 1 patient (4.5%) in the TT group (P > 0.05). Successfully cardioverted patients in whom no IRAF occurred were followed-up for 18 months under both warfarin and Class 1 or 3 antiarrhythmic drugs, as guided by the current ACC/AHA/ESC Guidelines. The rate of SR at 1, 3, 6, 12, and 18 months of follow-up was not significantly different between the 2 groups, and in an intention-to-treat analysis at 18 months, SR was present in 6 patients (23%) in the ICV group and in 10 patients (38%) in the TT group (P > 0.05). The majority of AF recurrences occurred within a month of successful CV in both groups (8/12 [67%] in the TT group and 15/18 [83%] in the ICV group, P > 0.05). The mortality, thromboembolic, and bleeding complication rates were similar in the 2 groups. In this prospective randomized comparison of TT and low energy ICV in patients with persistent AF, the 18-month rates of SR and major adverse clinical events were found to be similar.
No takes yet. Share an insight, caveat, or question.
Özdemir et al. (2006) conducted an RCT in Persistent atrial fibrillation (n=52). Low-energy internal cardioversion (ICV) vs. Transthoracic cardioversion (100-360 J monophasic shocks) was evaluated on Sinus rhythm maintenance at 18 months (intention-to-treat) (p=>0.05). Low-energy internal cardioversion and transthoracic cardioversion resulted in similar rates of sinus rhythm maintenance at 18 months (23% vs 38%, P>0.05) in persistent atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: