Low-energy internal cardioversion of atrial fibrillation after failed external cardioversion - Texas Heart Institute experience and review of the literature

In patients with atrial fibrillation, low-energy internal cardioversion may be used to restore sinus rhythm after external cardioversion fails. We use d this method in 8 consecutive patients with a mean age of 69.5 +/- 8.3 (SD ) years, 7 (87.5%) of whom were successfully treated with a mean 9.1 J (ran ge, 4 to 14 J). No patient had ventricular arrhythmias at the time of cardi oversion, or local groin complications afterward. One patient had recurrent atrial fibrillation the morning after cardioversion, and another patient h ad an embolus to the renal artery 20 days posttreatment. After 1 month, 5 p atients were still in sinus rhythm, and 7 patient was lost to follow-up. Th is study confirms the efficacy of internal cardioversion in this setting an d stresses the importance of a standard anticoagulation protocol before and after cardioversion.