Initial experience with single lead intracardial cardioversion for refractory XXXX .

@entity1 @entity2643 @entity943 @entity955
BACKGROUND: @entity955 ( @entity955 ) is a common @entity943 , associated with a substantial morbidity (thromboemboli, worsening left ventricular function). Established therapy for pharmacological refractory @entity955 is high-energy trans-thoracic electric cardioversion (TTCV), but this strategy is ineffective for 10-30% of the @entity1 . The purpose of the present study is to establish the safety and efficacy of low-energy intracardiac cardioversion (ICCV) with a relatively new balloon-guided single-catheter system with dual chamber pacing possibility for this group of @entity1 . METHODS: @entity1 in whom an attempt to restore sinus rhythm (SR) by TTCV under antiarrhythmic therapy failed were eligible for the study. For the ICCV-attempt, a single flow-guided atrial cardioversion catheter was used. Low-energy biphasic shocks of increasing energy (6-15 J) were delivered, if necessary in combination with intravenous @entity2643 , until SR was restored. In case of early recurrence of @entity955 , another attempt was made with immediate post-shock overdrive pacing (AOO) in order to suppress premature atrial activity. RESULTS: Initially, 14 of the 16 treated @entity1 (90%) were converted to SR successfully. In eight @entity1 additional @entity2643 i.v. was administered and in six @entity1 atrial overpacing was used after ICCV. In seven and five @entity1 , respectively, these strategies were successful. Long-term follow-up (1-3 months) showed that in nine @entity1 (56%) SR was preserved; eight of them on oral @entity2643 . No adverse events were seen during the procedure and follow-up, especially no bleedings, despite puncturing under adequate anticoagulation therapy. CONCLUSION: ICCV using a single atrial cardioversion catheter is a safe and effective method to restore SR in @entity1 in whom TTCV failed previously. Long-term follow-up of this procedure is comparable to that of other studies. Results are influenced by antiarrhythmic drug therapy, compliance and @entity1 selection.
