Successful external cardioversion of atrial fibrillation in patients referred to an electrophysiologist for internal cardioversion

Background: Internal cardioversion of atrial fibrillation with direct curre nt energy has become an increasingly employed technique for patients who fa il external cardioversion. Hypothesis: The purpose of this study was to determine whether internal car dioversion could be avoided by careful attention to cardioversion technique in a group of patients referred specifically for internal cardioversion af ter failed external cardioversion by community cardiologists. Methods: We p erformed external cardioversion utilizing two operators applying significan t pressure to the thorax with up to 360 J prior to the planned internal car dioversion in 20 patients referred for internal cardioversion after failed attempts at external cardioversion. Results Sixteen patients (80%) were successfully cardio-verted and avoided the risk, inconvenience, and cost of internal cardioversion. Conclusion: External cardioversion with significant anterior paddle pressur e by two operators can decrease the need for internal cardioversion in a si gnificant portion of patients referred to electrophysiologists for internal cardioversion and should be considered prior to an invasive procedure.