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Marked reduction in atrial defibrillation thresholds with repeated internal cardioversion

^a Medizinische Klinik, Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany
^b Deutsches Herzzentrum, Klinik an der Technischen Universität, Munich, Germany

View larger version (27K): [in a new window]   Figure 1 Study design for first and second internal cardioversion of chronic and recurrent AF. Beginning with a test shock of 60-V intensity, the voltage was increased in 40-V steps until cardioversion was achieved or to a maximum voltage of 580/240 V. The patients were sedated orally with 2.5 to 5 mg diazepam. Immediately before cardioversion, 1 mg midazolam was administered intravenously. Patients were asked to quantify their level of perceived pain by means of a scale ranging from 0 (= not felt) to 10 (= intolerable) after each shock applied.

View larger version (31K): [in a new window]   Figure 2 Changes in duration of AF (in days), defibrillation thresholds (in J), pain scores (measured by means of a scale ranging from 0 = not felt to 10 = intolerable) and dosage of midazolam (in mg) for repeated internal cardioversion (n = 18): Comparison between first (open symbols) and second cardioversion (filled symbols) with respect to defibrillation vectors (right atrium-coronary sinus [triangles], right atrium-pulmonary artery [circles]).

View larger version (28K): [in a new window]   Figure 3 Correlation between duration of AF (in days) before successful internal cardioversion and defibrillation thresholds (in J) for first (open symbols) and second (filled symbols) cardioversion of AF with respect to defibrillation vectors. (Top) Right atrium-coronary sinus (triangles). (Bottom) Right atrium-pulmonary artery (circles).

View larger version (26K): [in a new window]   Figure 4 Correlation between defibrillation thresholds (in J) for first (open symbols) and second (filled symbols) internal cardioversion and pain scores (measured by means of a scale ranging from 0 = not felt to 10 = intolerable) at successful internal cardioversion of chronic and recurrent AF with respect to defibrillation vectors. (Top) Right atrium-coronary sinus (triangles). (Bottom) Right atrium-pulmonary artery (circles).