Téma: 

Practical aspects of electrical cardioversion in patients with persistent atrial fibrillationľ

Ján Kmec

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, with an increasing prevalence in elderly population. The most important reason to restore sinus rhythm is symptom amelioration, improvement of haemodynamics, reduced risk of thromboembolic events and prevention of atrial remodeling. Cardioversion (CV) of AF on sinus rhythm can be done pharmacologically or electrically using standard transthoracic method or internal cardioversion. Electrical cardioversion (ECV) is a procedure whereby a synchronized electrical current (shock) is delivered through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back. Regardless of which technique is chosen, R-wave synchronization of shocks is mandatory to avoid induction of ventricular arrhythmias. Technical features affecting the success rate of external cardioversion are position and size of the electrodes, contact between skin and electrodes, pressure on electrodes, energy and number shocks delivered, waveform of the shocks, thoracic impedance. Most of extern defibrillators use the monophasic damped-sine wave shock. Two types of biphasics waveforms are available for external cardioversion: rectilinear and duncated exponential. However, the biphasic waveform shock is more effective then monophasic shock. Careful patient selection would ensure successful electrical cardioversion in over 90 % of cases. Patients with a high success rate of external cardioversion include: younger patients (aged < 60 years), with short duration of AF (< 1 year), no structural heart disease (that is, no valve disease, dilated atria or ventricles, preserved left ventricular function) and an identifiable precipitant (such as pyrexia, thyroid disease, etc). CV of patients with implanted pacemaker and defibrillator devices is feasible and safe when appropriate precautions are taken to prevent damage. The latest indication for electrical cardioversion in patients with AF is introduced in ACC/AHA/ESC 2006 Guidelines for management of patients with atrial fibrillation. Time performed of CV depends on symptoms and anticoagulation status. Complications of CV such as systemic emboli, pulmonary oedema, and hypotension, arrhythmias, myocardial injury, ST - T abnormalities, skin burn and pacemaker dysfunction are uncommon.

Ročník 2007  Témy časopisu Cardiology for practice 3 / 2007

CHAIRMAN OF THE EDITORIAL BOARD
doc. MUDr. Oľga Jurkovičová, CSc.

CHIEF CONSULTANT
prof. MUDr. Robert Hatala, PhD., FESC

MEMBERS OF THE EDITORIAL BOARD
MUDr. Peter Dědič
MUDr. Juraj Dúbrava, PhD., FESC
MUDr. Viliam Fridrich, PhD.
doc. MUDr. Ján Kmec, PhD.
MUDr. Gabriela Kaliská, PhD., FESC
MUDr. Pavol Lesný
MUDr. Monika Kaldarárová, PhD.
MUDr. Peter Margitfalvi
prof. MUDr. Daniel Pella, PhD.
prof. MUDr. Iveta Šimková, CSc., FESC
MUDr. Viera Vršanská, CSc.

PROFESSIONAL EDITOR
MUDr. Juraj Dúbrava, PhD., FESC

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Examples of citations:
1. Shaheen NJ, Crosby NA, Bozymski EM, et al. Is there publication bias in the reporting cancer risk in Barrett´ esophagus? Gastroenterology 2000; 119: 333-338.
2. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA): Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285: 430-436.
3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
5. Osborne BE. The electrocardiogram of the rat. In: Budden R, Detweiler DK, Zbinden G. The rat electrocardiogram in pharmacology and toxicology. Oxford: Pergamon Press 1981: 15-27.

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In which patients, after overcoming of a thromboembolic cerebral or peripheral event, the least suitable catheter closure is foramen ovale patents:
a. a woman before planned pregnancy
b. paroxysmal fibrillation of the atrium
c. aneurysm of the atrium septum
d. origination of an event after cough

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