EFFICACY OF A NEW BALLOON CATHETER FOR INTERNAL CARDIOVERSION OF CHRONIC ATRIAL-FIBRILLATION WITHOUT ANESTHESIA

Objective - To compare a new internal cardioversion system incorporate d into a balloon guided catheter with a conventional two electrode sys tem in patients with atrial fibrillation (AF). Design - Prospective st udy. Patients - 74 patients with chronic AF treated by internal cardio version. Materials - A 7.5 F balloon catheter with high energy electro de arrays each consisting of six 0.5 cm platinum rings. Brachial vein access enables one electrode array to be placed in the left pulmonary artery (distal pole) and the other at the lateral right atrial wall (p roximal pole). The conventional two electrode system consists of 6 F e lectrodes placed in the proximal left pulmonary artery (anode) and the lower right atrium. Interventions - Internal cardioversion was perfor med by shocks delivered in 40 V incremental steps from an external def ibrillator. Shocks were applied by the new device to 32 patients (grou p A) and by the conventional system to 42 patients (group B). Results - The groups differed with respect to system positioning (9.2 (7.3) v 12.3 (8.1) minutes, p < 0.05) and fluoroscopy times (1.7 (1.0) v 3.3 ( 2.1) minutes, p < 0.01). Sinus rhythm was restored in 30 patients of g roup A and in 39 of group B (NS) with mean (SD) energy requirements of 8.4 (3.1) J and 7.2 (3.1) J, respectively (NS). Conclusions-This new method of internal cardioversion has comparably high primary success r ates and low sedation requirements with single and two lead systems.