Internal low energy cardioversion of atrial fibrillation using a single lead system: comparison of a left and right pulmonary artery catheter approach.

SCHMIEDER, S., et al.: Internal Low Energy Cardioversion of Atrial Fibrillation Using a Single Lead System: Comparison of a Left and Right Pulmonary Artery Catheter Approach. Internal cardioversion (ICV) has been demonstrated as an effective and safe method for restoring sinus rhythm in patients with AF. Recently, a new single lead system with a balloon-guided cardioversion catheter was introduced. ICV was performed after advancing a 7.5 Fr catheter flow-directed into the left or right pulmonary artery (PA, distal array, cathode). The proximal array (anode) was placed at the lateral RA wall. Synchronized shocks (3/3 ms biphasic impulse) were applied using a stepwise protocol (0.5, 3, 6, 9, 12, 15 J) until sinus rhythm was restored or maximum energy (15 J) was reached. Sixty-five patients (mean age 58 ± 13 years) with acute and chronic AF were included. Sinus rhythm could be restored in 59 (91%) patients. Cardioversion success was 93% in the left PA compared to 86% in right PA. DFTs for the left and right PA approaches were 7.1 ± 4.0 J and 10.2 ± 4.0 J, respectively (P 7 days (7.2 ± 4.1 J) than for those with a recent onset of AF (5.6 ± 4.1 J), P = 0.0012. Shock impedance differed for the left and right PA lead configuration (53 ± 11 vs 49 ± 13 Ω, P < 0.05). A right PA lead configuration is as effective compared to a left PA catheter approach when performing ICV for AF. ICV with a single lead system is safe and cardioversion success is comparable to other internal and external cardioversion techniques. In combination with hemodynamic monitoring, flow-directed nonfluoroscopic catheter positioning is feasible and may serve as a valuable therapeutic and diagnostic tool in intensive care units.