TRANSESOPHAGEAL VERSUS TRANSCHEST DC CARDIOVERSION

Attempted cardioversion via the oesophagus (transoesophageal cardiover sion) was compared with the transchest approach (transchest cardiovers ion) in a randomized trial of 100 consecutive patients with atrial fib rillation. For the transoesophageal group, 30, 50 and 100 J were deliv ered via an oesophageal electrode with subsequent 200 and 360 J transc hest if required. For the transchest group, 50, 100, 200 and 360 J wer e delivered if required. In the transoesophageal group, 36/50 (72%) of patients cardioverted using the transoesophageal route alone, and in the transchest group, 41/50 (82%) of patients cardioverted (p = NS). F irst shock success was similar for the transoesophageal and transchest groups: 13/50 (26%) vs. 8/50 (16%) respectively. The mean number of s hocks required to achieve successful cardioversion was identical for t he transoesophageal and transchest groups (2.6). However, transoesopha geal cardioversion was more successful than transchest cardioversion a t energies less-than-or-equal-to 100 J (36/50 [72%], and 17/50 [34%], p < 0.05). Median total energy for successful cardioversion was lower for patients in the transoesophageal group (180 J) than the transchest group (350 J) and mean peak current at successful cardioversion was a lso lower for patients in the transoesophageal group (21.7 A) than the transchest group (27.3 A) (p < 0.05). No oesophageal complications oc curred. Thus, using an oesophageal electrode, cardioversion can be ach ieved as successfully as using the transchest route. The transoesophag eal approach offers a low impedance, and consequently a low-energy pat hway for cardioversion.