Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, the Netherlands,
Neth Heart J. 2013 Dec;21(12):548-53. doi: 10.1007/s12471-013-0474-z.
Atrial fibrillation (AF) and heart failure are conditions that often coexist. Consequently, many patients with an implantable cardioverter-defibrillator (ICD) present with AF. We evaluated the effectiveness of internal cardioversion of AF in patients with an ICD.
Retrospectively, we included 27 consecutive ICD patients with persistent AF who underwent internal cardioversion using the ICD. When ICD cardioversion failed, external cardioversion was performed.
Patients were predominantly male (89 %) with a mean (SD) age of 65 ± 9 years and left ventricular ejection fraction of 36 ± 17 %. Only nine (33 %) patients had successful internal cardioversion after one, two or three shocks. The remaining 18 patients underwent external cardioversion after they failed internal cardioversion, which resulted in sinus rhythm in all. A smaller left atrial volume (99 ± 36 ml vs. 146 ± 44 ml; p = 0.019), a longer right atrial cycle length (227 (186-255) vs. 169 (152-183) ms, p = 0.030), a shorter total AF history (2 (0-17) months vs. 40 (5-75) months, p = 0.025) and dual-coil ICD shock (75 % vs. 26 %, p = 0.093) were associated with successful ICD cardioversion.
Internal cardioversion of AF in ICD patients has a low success rate but may be attempted in those with small atria, a long right atrial fibrillatory cycle length and a short total AF history, especially when a dual-coil ICD is present. Otherwise, it seems reasonable to prefer external over internal cardioversion when it comes to termination of persistent AF.
心房颤动（AF）和心力衰竭常常同时存在。因此，许多植入式心脏复律除颤器（ICD）患者会出现 AF。我们评估了 ICD 患者中 AF 内部复律的效果。
我们回顾性地纳入了 27 例连续的持续性 AF 且使用 ICD 进行内部复律的 ICD 患者。当 ICD 复律失败时，进行外部复律。
患者主要为男性（89%），平均（SD）年龄为 65±9 岁，左心室射血分数为 36±17%。只有 9 例（33%）患者在一次、两次或三次电击后成功进行了内部复律。其余 18 例患者在内部复律失败后接受了外部复律，结果所有患者均恢复窦性节律。较小的左心房容积（99±36ml 比 146±44ml；p=0.019）、较长的右心房周期长度（227（186-255）比 169（152-183）ms，p=0.030）、较短的 AF 总病史（2（0-17）个月比 40（5-75）个月，p=0.025）和双线圈 ICD 电击（75%比 26%，p=0.093）与 ICD 复律成功相关。
ICD 患者的 AF 内部复律成功率较低，但对于那些心房较小、右心房颤动周期较长且 AF 总病史较短的患者，可以尝试进行复律，尤其是在使用双线圈 ICD 时。否则，在终止持续性 AF 时，外部复律似乎比内部复律更合理。
