Sopher S M, Murgatroyd F D, Slade A K, Blankoff I, Rowland E, Ward D E, Camm A J
St George's Hospital, London.
Heart. 1996 Jun;75(6):635-8. doi: 10.1136/hrt.75.6.635.
To investigate the efficacy of internal cardioversion using low energy shocks delivered with a biatrial electrode configuration in chronic atrial fibrillation resistant to transthoracic shocks.
Low energy internal cardioversion was attempted in 11 patients who had been in atrial fibrillation for 233 (SD 193) days and had failed to cardiovert with transthoracic shocks of 360 J in both apex-base and anterior-posterior positions. Synchronised biphasic shocks of up to 400 V (approximately 6 J) were delivered, usually with intravenous sedation only, between high surface area electrodes in the right atrium and the left atrium (coronary sinus in nine, left pulmonary artery in one, left atrium via patent foramen ovale in one).
Sinus rhythm was restored in 8/11 patients. The mean leading edge voltage of successful shocks was 363 (46) V [4.9 (1.2) J]. Higher energy shocks induced transient bradycardia [time to first R wave 1955 (218) ms]. No proarrhythmia or other acute complications were observed.
Low energy internal cardioversion of atrial fibrillation can restore sinus rhythm in patients in whom conventional transthoracic shocks have failed.
探讨采用双心房电极配置进行低能量电击内部心脏复律对经胸电击无效的慢性心房颤动的疗效。
对11例心房颤动持续233（标准差193）天且在尖 - 基和前后位均接受360 J经胸电击未能复律的患者尝试进行低能量内部心脏复律。在右心房和左心房（9例通过冠状窦，1例通过左肺动脉，1例通过卵圆孔未闭进入左心房）的高表面积电极之间给予高达400 V（约6 J）的同步双相电击，通常仅采用静脉镇静。
11例患者中有8例恢复窦性心律。成功电击的平均前沿电压为363（46）V [4.9（1.2）J]。较高能量的电击诱发短暂性心动过缓[至首个R波的时间为1955（218）ms]。未观察到促心律失常或其他急性并发症。
心房颤动的低能量内部心脏复律可使传统经胸电击失败的患者恢复窦性心律。
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