LOW-ENERGY CARDIOVERSION WITH EPICARDIAL WIRE ELECTRODES - NEW TREATMENT OF ATRIAL-FIBRILLATION AFTER OPEN-HEART-SURGERY

Background-Atrial fibrillation (AF) is the most common arrhythmia afte r open heart surgery. Traditional treatment with a range of antiarrhyt hmic drugs and electrical cardioversion is associated with considerabl e side effects. The aim of this study was to examine the feasibility a nd efficacy of low-energy atrial defibrillation with temporary epicard ial defibrillation wire electrodes. Methods and Results-Epicardial def ibrillation wire electrodes were placed at the left and right atria du ring open heart surgery in 100 consecutive patients (age 65+/-9 years; male to female ratio 67:23). Electrophysiological studies performed p ostoperatively revealed a test shock (0.3 J) impedance of 96+/-12 Omeg a (monophasic) and 97+/-13 Omega (biphasic). During their hospital sta y, AF occurred in 23 patients (23%) at 2.1+/-1.3 days postoperatively. Internal atrial defibrillation was performed in 20 patients. Of these patients, 80% (16/20) were successfully cardioverted with a mean ener gy of 5.2+/-3 J. Early recurrence of AF (less than or equal to 60 seco nds after defibrillation) developed in 8 patients. Five patients had m ultiple episodes of AF, In total, 35 episodes of AF were treated, with an 88% success rate. Only 6 patients (30%) required sedation. No comp lications were observed with shock application or with lead extraction . Conclusions-Atrial defibrillation with temporary epicardial wire ele ctrodes can be performed safely and effectively in patients after card iac operations. The shock energy required to restore sinus rhythm is l ow. Thus, patients can be cardioverted without anesthesia.