The long-term follow-up results of the Electrical Cardioversion of Chronic Nonvalvular Atrial Fibrillation.
- Author:
Sang Hoon LEE
1
;
Sung Je CHO
;
Seong Hee JEON
;
Kyung Whan KO
;
Jae Hyung YOON
;
Su Geum LEE
;
Min Su HYON
;
Myung A KIM
;
Seong Hoon PARK
Author Information
1. Department of Internal Medicine, Sejong General Hospital.
- Publication Type:Original Article
- Keywords:
Atrial Fibrillation;
DC cardioversion;
Amiodarone
- MeSH:
Amiodarone;
Atrial Fibrillation*;
Echocardiography;
Echocardiography, Transesophageal;
Electric Countershock*;
Female;
Follow-Up Studies*;
Heart Diseases;
Humans;
Prospective Studies;
Thrombosis;
Warfarin
- From:Korean Journal of Medicine
1999;56(4):450-458
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVES:We performed a prospective observation for the patients with chronic nonvalvular atrial fibrillation who underwent electrical cardioversion after failed pharmacological cardioversion with amiodarone. The aim of this study was to look at the immediate sinus conversion rate, the maintenance rate of sinus rhythm at long-term follow-up, and the clinical and echocardiographic parameters that influence on the rate of immediate sinus conversion and maintenance of sinus rhythm. At simultaneously, we intended to evaluate the efficacy of electrical cardioversion for the patients with chronic nonvalvular atrial fibrillation. METHODS: After anticoagulation therapy with coumadine for four weeks before cardioversion, we tried pharmacological cardioversion with amiodarone first. Failed cases included in this study. The direct current cardioversion was performed under transesophageal echocardiography monitoring to exclude the left atrial thrombus and to measure various echocardiographic parameters. After successful sinus cardioversion, we prescribed amiodarone with maintenance doses and coumadine at least 4 weeks. Transthoracic echocardiography was performed before cardioversion and one day, one month, 3 months, 6 months, and 9 months after sinus conversion. The minimum duration of atrial fibrillation was one month before the trial of pharmacological cardioversion. RESULTS: 1) The total number of patients was forty three (male: 28, female: 15, average age: 60+/-9). The initial success rate of sinus conversion was 88 %. 2) The maintenance rate of sinus rhythm with maintenance dose of amiodarone was 52 % after 9 months follow-up. 3) The direct current cardioversion was performed to 10 patients among 17 patients who recurred atrial fibrillation after sinus conversion. Among 10 patients, 5 patients of them were converted to sinus rhythm and maintained sinus rhythm after 9 months follow-up. 4) The initial success rate of sinus conversion was significantly higher in patients with lone atrial fibrillation compared with those patients with other associated heart disease (100 % vs. 83 %, p < 0.05), but the long-term maintenance rate of sinus rhythm was not influenced by the presence of associated disease. 5) The duration of atrial fibrillation before cardioversion was shorter in patients who were naintained sinus rhythm than that of those who were recurred atrial fibrillation. 6) The initial energy requirement at sinus conversion was lower in the patients who were maintained sinus rhythm than that of those who were recurred atrial fibrillation at 9 months follow-up. CONCLUSIONS: Direct current cardioversion was an effective treatment modality for patients with chronic nonvalvular atrial fibrillation after failure of pharmacological cardioversion with amiodarone.
