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Transvenous low energy internal cardioversion for atrial fibrillation refractory to external cardioversion: do non-obese patients benefit?
  1. D Pavin,
  2. H Legrand,
  3. C Leclercq,
  4. C Crocq,
  5. P Mabo,
  6. J C Daubert
  1. Département de Cardiologie et Maladies Vasculaires, Centre Hospitalier, Universitaire, Rennes, France
  1. Correspondence to:
    Dr D Pavin
    Département de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes, France;

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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.


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 …

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