INTERNAL ATRIAL DEFIBRILLATION AFTER FAILURE OF ATTEMPTED PHARMACOLOGICAL AND EXTERNAL ELECTRICAL CARDIOVERSION

Cardioversion of atrial fibrillation by an endocavitary electrical sho ck was first proposed during the 1980s. The authors studied the effica cy of this technique at short and medium term in a population of 36 pa tients (28 men and 8 women) in whom atrial fibrillation persisted desp ite attempts to reduce it by antiarrhythmic drugs and external electri cal cardioversion. The immediate success rate was high : 34 out of 36 patients (94 %) and, at medium term, the number with sinus rhythm was comparable to that of studies evaluating the medium-term efficacy of e xternal electrical cardioversion; 19 out of 33 patients (57 %) were in sinus rhythm at 6 months and 9 out of 27 patients (33 %) at 12 months . These results seem to justify attempts at internal atrial defibrilla tion in patients in whom the other two techniques of cardioversion hav e failed. Its use as the method of first intention could be proposed i f the profile of ''resistant'' patients to classical techniques was kn own, which is unfortunately not presently the case.