Mairesse Georges H, Raepers Monique, Legrand Isabelle, Baroud Imad, Deheneffe Yvon, Emonts Michel, Paquay Jean-Louis, Mitri Kamal
Cliniques du Sud-Luxembourg, Arlon, Belgium.
J Interv Card Electrophysiol. 2003 Dec;9(3):371-5. doi: 10.1023/a:1027403729049.
Internal electrical cardioversion is currently used in patients with persistent atrial fibrillation resistant to external electrical cardioversion. In external cardioversion, biphasic waveforms have shown a greater efficacy than monomorphic waveforms. The present study aimed to test the safety and efficacy of rectilinear biphasic waveform in converting patients with persistent atrial fibrillation to sinus rhythm using internal electrical cardioversion, and to compare it with that of classical monophasic waveform. Twenty-seven consecutive patients with persistent AF received 31 internal cardioversions, using monophasic waveform in 11 (group I), and rectilinear biphasic waveform in 20 cases (group II). Baseline patients characteristics were similar in both groups. Multipolar catheters were positioned in the distal coronary sinus and in the high right atrium. Synchronised shocks were delivered using an escalating protocol of 2, 5, 10, 15, 20, 30, and 50 Joules. In group I, 1 patient was resistant to maximal energy (success rate 91%). The mean energy of the maximal shock was 18 +/- 13 J. In group II, all patients were converted to sinus rhythm. The mean energy of the maximal shock was 9 +/- 5 J (p < 0.01 vs. group I). No significant complications occurred. At 3 months follow-up, 45% of group I and 60% of group II patients remained in sinus rhythm (p = NS). We conclude that internal cardioversion using rectilinear biphasic waveform is feasible and safe, and requires less energy than classical monophasic waveforms.
目前，体内电复律用于对体外电复律耐药的持续性房颤患者。在体外电复律中，双相波显示出比单相波更高的疗效。本研究旨在测试使用体内电复律将持续性房颤患者转为窦性心律时直线双相波的安全性和有效性，并将其与经典单相波进行比较。27例连续的持续性房颤患者接受了31次体内复律，其中11例使用单相波（I组），20例使用直线双相波（II组）。两组患者的基线特征相似。多极导管置于远端冠状窦和高位右心房。使用2、5、10、15、20、30和50焦耳的递增方案进行同步电击。在I组中，1例患者对最大能量无反应（成功率91%）。最大电击的平均能量为18±13焦耳。在II组中，所有患者均转为窦性心律。最大电击的平均能量为9±5焦耳（与I组相比，p<0.01）。未发生明显并发症。在3个月的随访中，I组45%的患者和II组60%的患者维持窦性心律（p=无显著性差异）。我们得出结论，使用直线双相波进行体内复律是可行且安全的，并且比经典单相波需要更少的能量。
