Incidence and modes of onset of early reinitiation of atrial fibrillation after successful internal cardioversion, and its prevention by intravenous sotalol

Autor: C P Lau, Hung-Fat Tse, G M Ayers
Rok vydání: 1999
Předmět:
Adult
Male
Bradycardia
medicine.medical_specialty
Heart disease
Defibrillation
medicine.medical_treatment
Adrenergic beta-Antagonists
Electric Countershock
Antiarrhythmic agent
QRS complex
Recurrence
Risk Factors
Internal medicine
Atrial Fibrillation
Heart rate
Sotalol - therapeutic use
medicine
Humans
cardiovascular diseases
Infusions
Intravenous
Aged
Retrospective Studies
Aged
80 and over
business.industry
Sotalol
Atrial fibrillation
Middle Aged
medicine.disease
Low energy cardioversion
Atrial fibrillation - etiology - prevention & control - therapy
Anesthesia
Adrenergic beta-antagonists - therapeutic use
Papers
Chronic Disease
cardiovascular system
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Anti-arrhythmia agents - therapeutic use
Anti-Arrhythmia Agents
medicine.drug
Zdroj: Heart. 82:319-324
ISSN: 1355-6037
DOI: 10.1136/hrt.82.3.319
Popis: Objectives - To study the incidence and mode of onset of early reinitiation of atrial fibrillation (ERAF) following successful internal cardioversion of chronic atrial fibrillation, and to determine the effects of sotalol in the prevention of ERAF. Design - The incidence and modes of onset of ERAF and the acute effects of intravenous sotalol in the prevention of ERAF were studied retrospectively. Setting - Electrophysiology laboratory at a university teaching hospital. Patients - 64 patients, mean (SD) age 62 (10) years, who underwent internal cardioversion of chronic atrial fibrillation (mean duration of atrial fibrillation 31 (39) months). Main outcome measures - ECGs and intracardiac electrograms recorded during the internal cardioversion of atrial fibrillation using 3/3 ms biphasic, R wave synchronised shocks. Results - 52 patients (81%) had successful electrical cardioversion, and 20 (31%) of these had ERAF during the procedure. There was no clinical predictor for the occurrence of ERAF. Fifty eight episodes of ERAF were observed. Five ERAF episodes (9%) had preceding bradycardia and 53 (91%) of these were triggered by atrial premature beats with normal preceding heart rate. Atrial premature beats that reinitiated atrial fibrillation had a shorter coupling interval (333 (43) ms υ 396 (100), p < 0.001) and a lower prematurity index (0.44 (0.11) υ 0.55 (0.14), p < 0.001) than those that did not reinitiate atrial fibrillation. Repeated shock delivery and increasing the defibrillation energy did not prevent ERAF. Intravenous sotalol infusion decreased the numbers of atrial premature beats and prolonged their coupling interval, and prevented ERAF after repeated defibrillation in 83% of patients with ERAF. Conclusions - ERAF is a significant clinical problem after successful internal cardioversion of chronic atrial fibrillation, and was observed in up to 31% of patients. In most episodes, ERAF was triggered by short coupling atrial premature beats with preceding normal heart rate. Intravenous sotalol was effective in preventing ERAF in most cases.
published_or_final_version
Databáze: OpenAIRE
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