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- AF, atrial fibrillation
- EEC, external electrical cardioversion
- LEIC, low energy internal cardioversion
- LVEF, left ventricular ejection fraction
In patients with persistent atrial fibrillation (AF), restoration of sinus rhythm can be accomplished by external electrical cardioversion (EEC) with a 70−90% success rate. The effectiveness of external cardioversion is linked to transthoracic impedance. Total body weight is a significant factor in determining transthoracic impedance and cardioversion failure is more frequent in obese patients.1 The technique of transvenous low energy internal cardioversion (LEIC) overcomes those limitations.2 It remains to be established if LEIC will be an effective therapeutic option in non-obese patients in which failure of external cardioversion may be caused by the underlying heart disease and long term sinus rhythm maintenance more problematic.
The aim of this prospective study was to assess the immediate and long term effectiveness of LEIC in a series of consecutive patients with persistent AF refractory to EEC, with special reference to the outcome in obese and non-obese patients.
PATIENTS AND METHODS
Consecutive patients with persistent AF (⩾ 8 days) refractory to transthoracic monophasic shocks (with at least two attempts at 360 J in an anteroposterior paddle position) were included. A cardioversion attempt was designated as unsuccessful if sinus rhythm was not restored for at least one beat. Exclusion criteria were: (1) hyperthyroidism; (2) acute and transient cause of AF; (3) decompensated heart failure at the time of attempted cardioversion; (4) cardiac surgery …