New advances in external cardioversion of atrial fibrillation
Atrial fibrillation is the most frequently encountered sustained arrhythmia in clinical practice. Although electrical cardioversion of atrial fibrillation using damped sine wave monophasic shocks has been a mainstay of therapy for nearly four decades, it continues to be limited by an unacceptable failure rate, even with shocks of up to 360 J. Although several alternatives have been proposed, including 720 J shocks using dual monophasic defibrillators, ibutilide pretreatment, and internal cardioversion, each of these approaches has significant limitations, which preclude its routine use. Recent data demonstrate that standard use of rectilinear biphasic shocks for cardioversion of atrial fibrillation is associated with nearly 100% cardioversion efficacy. Rectilinear biphasic shocks appear to be particularly effective in patients with high transthoracic impedance, a group that has traditionally fared poorly with damped sine wave monophasic shocks. Current data suggest that biphasic shocks may be the preferred method for the transthoracic electrical cardioversion of atrial fibrillation © 2001 CVRR, Inc.
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