External cardioversion of atrial fibrillation in patients with implanted pacemaker or cardioverter-defibrillator systems: A randomized comparison of monophasic and biphasic shock energy application

Johannes C. Manegold, Carsten W. Israel, Joachim R. Ehrlich, G. Duray, Dmitri Pajitnev, Florian T. Wegener, Stefan H. Hohnloser

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Aims: External cardioversion (ECV) of atrial fibrillation (AF) may damage implanted pacemaker and cardioverter-defibrillator (ICD) systems. This prospective study evaluated the safety and efficacy of ECV comparing mono- to biphasic shock waveforms in patients with implanted rhythm devices. Methods and results: Patients with pacemaker or ICD systems and an indication for ECV were randomized to receive mono- or biphasic shocks. Systems were tested immediately before and after ECV, 1 h and 1 week later with respect to device and lead integrity. Forty-four patients (71 ± 10 years, 31 male; 29 pacemakers, 12 ICDs, three cardiac resynchronization systems) underwent ECV with antero-posterior paddle orientation (monophasic in 21 and biphasic in 23 patients). Pacing impedances were reduced immediately after ECV (atrial 402-392 Ω, P <0.001; ventricular 517-496 Ω, P = 0.001) and returned to baseline values within 1 week. Ventricular sensing was reduced immediately after ECV (12.4-11.6 mV, P = 0.004). There was no device or lead dysfunction in any patient. ECV was successful in 42/44 patients (95%), cumulative energy was significantly lower for biphasic compared with monophasic shocks (P = 0.001). Conclusion: ECV for AF seems to be safe and effective in patients with implanted rhythm devices.

Original languageEnglish
Pages (from-to)1731-1738
Number of pages8
JournalEuropean Heart Journal
Volume28
Issue number14
DOIs
Publication statusPublished - Jun 2007

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Electric Countershock
Defibrillators
Atrial Fibrillation
Shock
Equipment and Supplies
Cardiac Resynchronization Therapy
Electric Impedance
Prospective Studies
Safety

Keywords

  • Atrial fibrillation
  • Biphasic shocks
  • Cardioversion
  • Implantable cardioverter-defibrillator
  • Monophasic shocks
  • Pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

External cardioversion of atrial fibrillation in patients with implanted pacemaker or cardioverter-defibrillator systems : A randomized comparison of monophasic and biphasic shock energy application. / Manegold, Johannes C.; Israel, Carsten W.; Ehrlich, Joachim R.; Duray, G.; Pajitnev, Dmitri; Wegener, Florian T.; Hohnloser, Stefan H.

In: European Heart Journal, Vol. 28, No. 14, 06.2007, p. 1731-1738.

Research output: Contribution to journalArticle

Manegold, Johannes C. ; Israel, Carsten W. ; Ehrlich, Joachim R. ; Duray, G. ; Pajitnev, Dmitri ; Wegener, Florian T. ; Hohnloser, Stefan H. / External cardioversion of atrial fibrillation in patients with implanted pacemaker or cardioverter-defibrillator systems : A randomized comparison of monophasic and biphasic shock energy application. In: European Heart Journal. 2007 ; Vol. 28, No. 14. pp. 1731-1738.
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AU - Israel, Carsten W.

AU - Ehrlich, Joachim R.

AU - Duray, G.

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AU - Wegener, Florian T.

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AB - Aims: External cardioversion (ECV) of atrial fibrillation (AF) may damage implanted pacemaker and cardioverter-defibrillator (ICD) systems. This prospective study evaluated the safety and efficacy of ECV comparing mono- to biphasic shock waveforms in patients with implanted rhythm devices. Methods and results: Patients with pacemaker or ICD systems and an indication for ECV were randomized to receive mono- or biphasic shocks. Systems were tested immediately before and after ECV, 1 h and 1 week later with respect to device and lead integrity. Forty-four patients (71 ± 10 years, 31 male; 29 pacemakers, 12 ICDs, three cardiac resynchronization systems) underwent ECV with antero-posterior paddle orientation (monophasic in 21 and biphasic in 23 patients). Pacing impedances were reduced immediately after ECV (atrial 402-392 Ω, P <0.001; ventricular 517-496 Ω, P = 0.001) and returned to baseline values within 1 week. Ventricular sensing was reduced immediately after ECV (12.4-11.6 mV, P = 0.004). There was no device or lead dysfunction in any patient. ECV was successful in 42/44 patients (95%), cumulative energy was significantly lower for biphasic compared with monophasic shocks (P = 0.001). Conclusion: ECV for AF seems to be safe and effective in patients with implanted rhythm devices.

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