Santini Luca, Magris Barbara, Topa Alessia, Gallagher Mark M, Forleo Giovanni B, Papavasileiou Lida P, Borzi Mauro, Romeo Francesco, Santini Massimo
Department of Cardiology, University of Rome Tor Vergata, Italy.
J Cardiovasc Med (Hagerstown). 2007 Jul;8(7):488-93. doi: 10.2459/01.JCM.0000278440.74117.fe.
External electrical cardioversion is commonly used in the management of atrial fibrillation (AF), but usually involves general anaesthesia. We tested the efficacy, safety and tolerability of a minimally invasive cardioversion technique, not requiring general anaesthesia, performed on an outpatient basis.
We performed outpatient oesophageal cardioversion in 87 consecutive patients (mean age: 67.5 +/- 9.6 years; weight: 77.47 +/- 12.34 kg; left atrium diameter: 46.25 +/- 6.85 mm; LVEF: 55.5 +/- 16%) with persistent AF (mean duration: 6.99 +/- 11.55 months). A biphasic shock was delivered via an oesophageal decapolar lead (cathode) and two precordial patches (anode) under a mild sedation (midazolam 2.5-5 mg). In the first 25 patients, a step-up protocol (from 10 to 100 J) was performed whereas, in the other 62, a first shock at 50 J and a second one at 100 J, were delivered.
Patients described the level of discomfort caused by the procedure according a five-grade scale. Cardioversion was achieved in 97.7% of patients using a mean effective energy of 51.2 +/- 15.7 J. In 88.5% of patients, sinus rhythm was restored by using 50 J or less. No complications occurred and no patient required hospital admission. Mean discomfort score was 1.56 +/- 0.74 out of 5. Sinus rhythm persisted in 62.6% of patients at the 1-month follow-up.
Outpatient oesophageal cardioversion is a safe, acceptable and effective way to cardiovert patients with AF. It may be a useful alternative to external cardioversion. A relatively high starting energy (50 J) was demonstrated to be superior to a low-energy step-up technique.
体外电复律常用于心房颤动（AF）的治疗，但通常需要全身麻醉。我们测试了一种微创复律技术的疗效、安全性和耐受性，该技术无需全身麻醉，可在门诊进行。
我们对87例持续性AF患者（平均年龄：67.5±9.6岁；体重：77.47±12.34 kg；左心房直径：46.25±6.85 mm；左心室射血分数：55.5±16%）进行了门诊食管复律（平均病程：6.99±11.55个月）。在轻度镇静（咪达唑仑2.5 - 5 mg）下，通过食管十极导联（阴极）和两个胸前贴片（阳极）给予双相电击。在前25例患者中，采用递增方案（从10 J到100 J），而在其他62例患者中，首次电击能量为50 J，第二次为100 J。
患者根据五级量表描述了该操作引起的不适程度。97.7%的患者使用平均有效能量51.2±15.7 J实现了复律。88.5%的患者使用50 J或更低能量恢复了窦性心律。未发生并发症，无需患者住院。平均不适评分为1.56±0.74（满分5分）。1个月随访时，62.6%的患者窦性心律持续存在。
门诊食管复律是一种安全、可接受且有效的AF患者复律方法。它可能是体外复律的一种有用替代方法。相对较高的起始能量（50 J）被证明优于低能量递增技术。
