Andraghetti A, Scalese M
Medical PATH, Milan, Italy.
Europace. 2001 Jan;3(1):4-9. doi: 10.1053/eupc.2000.0137.
To present some safety and efficacy issues of low-energy internal cardioversion of chronic atrial fibrillation from 500 consecutive procedures performed with two different techniques, using either two single-coil catheters, or a single twin-coil catheter.
Low-energy internal cardioversion was carried out in 368 patients by means of two defibrillation catheters: the former was positioned in the right atrium and the latter either in the left pulmonary artery (212 patients), or in the distal coronary sinus (156 patients). In the remaining 132 patients, a single twin-coil catheter was positioned with the distal coil either in the pulmonary artery (75 patients) or in the coronary sinus (57 patients), while the proximal coil was in the right atrium. The external defibrillator delivered truncated biphasic shocks (6/6 ms, tilt 50%), with a voltage of 10-400 V. In 283 patients (57%) external cardioversion had been unsuccessfully tried before low-energy internal cardioversion. After a total of 1118 shocks, the overall success rate was 92.2% (91.3% with two catheters and 94.7% with the single catheter); the success rate was 93.4 and 91.3% with the coronary sinus and the pulmonary artery approach, respectively. The mean energy used was 6.5 +/- 3.4 J (voltage: 320 +/- 45 V); no difference was found between the twin catheter (6.3 +/- 3.1 J) and the single catheter approach (6.9 +/- 3.7 J), while the coronary sinus configuration required a significantly lower energy than the pulmonary artery configuration (5.6 +/- 2.9 vs 7.2 +/- 3.8 J, P < 0.05). The duration of the current atrial fibrillation episode was the only clinical characteristic statistically different between the 461 successfully cardioverted patients and the 39 failures (295 vs 727 days, P < 0.01). No complication was recorded during or after the delivery of the therapy; no procedure had to be terminated because of patient's intolerance.
Low-energy internal cardioversion is a safe and effective procedure for converting chronic atrial fibrillation, confirmed by this large multicentre experience. The newly available twin-coil catheter seems to achieve a slightly better success rate compared with the traditional two-catheter technique, and is associated with the same safety profile.
通过500例采用两种不同技术（使用两根单线圈导管或一根双线圈导管）进行的连续慢性房颤低能量心内复律手术，呈现一些安全性和有效性问题。
368例患者通过两根除颤导管进行低能量心内复律：一根置于右心房，另一根置于左肺动脉（212例患者）或冠状窦远端（156例患者）。其余132例患者使用一根双线圈导管，远端线圈置于肺动脉（75例患者）或冠状窦（57例患者），近端线圈置于右心房。体外除颤器发放截断双相电击（6/6毫秒，倾斜度50%），电压为10 - 400伏。在283例患者（57%）中，低能量心内复律前曾尝试体外复律但未成功。总共进行1118次电击后，总体成功率为92.2%（两根导管为91.3%，单根导管为94.7%）；冠状窦和肺动脉途径的成功率分别为93.4%和91.3%。平均使用能量为6.5±3.4焦耳（电压：320±45伏）；双导管（6.3±3.1焦耳）和单导管方法（6.9±3.7焦耳）之间未发现差异，而冠状窦配置所需能量明显低于肺动脉配置（5.6±2.9对7.2±3.8焦耳，P<0.05）。当前房颤发作持续时间是461例成功复律患者和39例失败患者之间唯一有统计学差异的临床特征（295对727天，P<0.01）。治疗期间或之后未记录到并发症；没有手术因患者不耐受而不得不终止。
低能量心内复律是一种安全有效的慢性房颤转复方法，这一大型多中心经验证实了这一点。新的双线圈导管与传统双导管技术相比，似乎成功率略高，且安全性相同。
