Transoesophageal low-energy cardioversion of atrial fibrillation - Resultswith the oesophageal-right atrial lead configuration

Background Low energy internal cardioversion is a safe and effective proced ure to restore sinus rhythm in patients with atrial fibrillation refractory to external cardioversion. However the procedure is invasive and fluorosco py is mandatory. Aim of the study To assess the efficacy, safety and tolerability of a new s implified procedure of low energy internal cardioversion. Methods Twenty-five consecutive patients (19 males and 6 females) with pers istent atrial fibrillation were submitted to low energy internal cardiovers ion using a step-up protocol (in steps of 50 V, starting from 300 V). A lar ge surface area lead (cathode) was positioned in the oesophagus, 45 cm from the nasal orifice. A second large surface area lead (anode) was positioned in the right atrium. A quadripolar lead was positioned at the right ventri cular apex to achieve ventricular synchronization and back-up pacing. Oesop hageal endoscopy was performed within 24 h of the end of the procedure and repeated after 48 h, if injury to the oesophageal mucosa had occurred. Results Sinus rhythm was restored in 23 patients (92%) with a mean delivere d energy of 15.74 J (range 5-27) and a mean impedance of 48 Ohm. In two pat ients, endoscopy revealed that small burns had occurred in the oesophageal mucose. Such lesions spontaneously healed after 48 h. Conclusions This new technique of performing low energy internal cardiovers ion is effective and safe and avoids the positioning of a lead in the coron ary sinus or in the left pulmonary artery, thereby simplifying the procedur e. (Eur Heart J 2000; 21: 848-855) (C) 2000 The European Society of Cardiol ogy.