Defibrillation of Atrial Fibrillation is not Associated with Increased Risk of Ventricular Fibrillation – The VCD-Trial (Clinical Trial of Electrical Therapy for Atrial Fibrillation using R-wave Guided Cardioversion Versus Defibrillation)
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Abstract
Background: Because of a possible risk of induction of Ventricular Fibrillation (VF) by defibrillation of atrial fibrillation (AF) postulated by LOWN and coworkers, synchronized cardioversion is used worldwide. This prospective, randomized study assessed the efficacy and safety between R-wave controlled cardioversion and defibrillation of AF at 2 study centers in Cologne, Germany.
Hypothesis: Defibrillation is not significantly different from cardioversion primarily in the occurrence of VF or sustained Ventricular Tachycardia (VT) and secondarily in restoring sinus rhythm, inducing non-sustained VT, asystole, or bradycardia.
Methods: 146 patients at an outpatient practice and 122 at the university hospital were randomized to cardioversion (n = 140) or defibrillation (n = 124).
Results: Cardioversion was successful in 92.1% of cases and defibrillation in 87.1%. The difference in efficacy was not statistically significant. In n = 1 patients receiving defibrillation, VF occurred after the first shock (200J) and immediate defibrillation (200J) restored sinus rhythm. In the n = 1 case, asystole occurred during cardioversion which terminated spontaneously. In n = 1 patients cardioverted and n = 2 who were defibrillated, sinus bradycardia occurred requiring Atropine in two cases. There were no thromboembolic events within 10 days. N = 9 patients reverted to AF within two hours. No patients died.
Conclusion: Electrical conversion of AF can be performed with similar results and low risk with both R-wave-triggered cardioversion and defibrillation. In particular, defibrillation with higher energies (> 100J) can be performed as effectively and safely without a statistically significant increased risk of VF or VT. There was no difference in efficacy and risk between electrotherapy performed in the outpatient and inpatient settings.
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Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825-1833. Available from: https://doi.org/10.1056/nejmoa021328
Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J. 2006;27:1979-2030. Available from: https://doi.org/10.1161/circulationaha.106.177292
Lown B, Amarasingham R, Neuman J. New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. JAMA. 1962;182:548-555. Available from: https://pubmed.ncbi.nlm.nih.gov/13931298/
King B. The effect of electric shocks on heart action with special reference to varying susceptibility in different parts of the cardiac cycle. New York, N.Y.: Columbia University; 1934. PhD dissertation. Available from: https://doi.org/10.3181/00379727-31-7355P
Kavanagh-Gray D. Non-synchronized direct-current countershock in cardiac arrhythmias. Can Med Assoc J. 1967;96(22):1460-1462. Available from: https://pubmed.ncbi.nlm.nih.gov/6025722/
Waris EK, Scheinin TM, Kreus KE, Salokannel J, Scheinin BM. Non-synchronized direct current countershock. Acta Med Scand. 1965;178:309-320.
Ross EM. Cardioversion causing ventricular fibrillation. Arch Intern Med. 1964;114:811-814. Available from: https://doi.org/10.1001/archinte.1964.03860120123015
Birgersdotter-Green U, Undesser K, Fujimura O, Feld GK, Kass RM, Mandel WJ, et al. Correlation of acute and chronic defibrillation threshold with upper limit of vulnerability determined in normal sinus rhythm. J Interv Card Electrophysiol. 1999;3:155-161. Available from: https://doi.org/10.1023/a:1009825731592
Collins LJ, Silverman DI, Douglas PS, Manning WJ. Cardioversion of nonrheumatic atrial fibrillation. Reduced thromboembolic complications with 4 weeks of precardioversion anticoagulation are related to atrial thrombus resolution. Circulation. 1995;92(2):160-163. Available from: https://doi.org/10.1161/01.cir.92.2.160
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. Available from: https://doi.org/10.1093/eurheartj/ehaa612
Kirchhof P, Eckardt L, Loh P, Weber K, Fischer RJ, Seidl KH, et al. Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. Lancet. 2002;360(9342):1275-1279. Available from: https://doi.org/10.1016/s0140-6736(02)11315-8
Herregods LL, Bossuyt GP, De Baerdemaeker LE, Moerman AT, Struys MM, Den Blauwen NM, et al. Ambulatory electrical external cardioversion with propofol or etomidate. J Clin Anesth. 2003;15(2):91-96. Available from: https://doi.org/10.1016/s0952-8180(02)00520-2
Franzen D, Brombach K, Möbius H. Ambulatory electrical cardioversion of atrial fibrillation. Int J Cardiol. 2006;107(3):303-306. Available from: https://doi.org/10.1016/j.ijcard.2005.03.043
Hou CJ, Zheng ZJ, Wu J, et al. Determination of ventricular vulnerable period and ventricular fibrillation threshold by use of T-wave shocks in patients undergoing implantation of cardioverter/defibrillators. Circulation. 1995;92(9):2558-2564. Available from: https://pubmed.ncbi.nlm.nih.gov/7586357/