Electrical Conversion of Atrial Fibrillation

Abstract

Article1 August 1966Electrical Conversion of Atrial FibrillationImmediate and Long-term Results and Selection of PatientsJAMES J. MORRIS JR., M.D., ROBERT H. PETER, M.D., HENRY D. MCINTOSH, M.D., F.A.C.P.JAMES J. MORRIS JR., M.D., ROBERT H. PETER, M.D., HENRY D. MCINTOSH, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-65-2-216 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptFor many years the major therapeutic approach for reverting atrial fibrillation to sinus rhythm has been through the use of quinidine. In 1962 Lown, Amarasingham, and Neuman (1) introducted direct-current shock as a method for terminating atrial fibrillation. This method has since proved to be a major advance over drug therapy in restoring atrial fibrillation to sinus rhythm. However, before the ultimate role of such therapy can be established, three major questions must be answered affirmatively:1. Can the patient expect to experience significant physiologic improvement when sinus rhythm is restored?2. Is this technique safe and effective?3. Can...References1. LOWNAMARASINGHAMNEUMAN BRJ: New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. JAMA 182: 548, 1962. MedlineGoogle Scholar2. MORRISKONGNORTHMCINTOSH JJYWCHD: Experience with "cardioversion" of atrial fibrillation and flutter. Amer. J. Cardiol 14: 94, 1964. CrossrefMedlineGoogle Scholar3. PETERMORRISMCINTOSH RHJJHD: The relationship of fibrillatory waves and P waves in the electrocardiogram. Circulation 33: 599, 1966. CrossrefMedlineGoogle Scholar4. MORRISESTESWHALENTHOMPSONMCINTOSH JJEHREHKHD: P-wave analysis in valvular heart disease. Circulation 29: 242, 1964. CrossrefMedlineGoogle Scholar5. SOKOLOWBALL MRF: Factors influencing conversion of chronic atrial fibrillation with special reference to serum quinidine concentration. Circulation 14: 568, 1956. CrossrefMedlineGoogle Scholar6. LOWNPERLROTHKAIDBEYABEHARKEN BMGSTDE: "Cardioversion" of atrial fibrillation. A report on the treatment of 65 episodes in 50 patients. New Eng. J. Med. 269: 325, 1963. CrossrefMedlineGoogle Scholar7. ORAMDAVIES SJP: Further experience of electrical conversion of atrial fibrillation to sinus rhythm: analysis of 100 patients. Lancet 1: 1294, 1964. CrossrefMedlineGoogle Scholar8. LEMBERGCASTELLANOSSWENSONGOSSELIN LAJA: Arrhythmias related to cardioversion. Circulation 30: 163, 1964. CrossrefMedlineGoogle Scholar9. MILLER HS: Synchronized precordial electroshock for control of cardiac arrhythmias; initial results and success after three months. JAMA 189: 549, 1964. CrossrefMedlineGoogle Scholar10. KILLIP T: Synchronized D.C. precordial shock for arrhythmias. Safe new technique to establish normal rhythm may be utilized on an elective or an emergency basis. JAMA 186: 1, 1963. CrossrefMedlineGoogle Scholar11. STOCK RJ: Cardioversion without anesthesia. New Eng. J. Med. 269: 534, 1963. CrossrefGoogle Scholar12. WILLIS WH: Letter to the editor. Direct-current countershock. Amer. Heart J. 67: 575, 1964. CrossrefMedlineGoogle Scholar13. RABBINOLIKOFFDREIFUS MDWLS: Complications and limitations of direct-current countershock. JAMA 190: 417, 1964. CrossrefMedlineGoogle Scholar14. KERTHSELTZERKEYANIGERBODE WJAKF: The electrical conversion of cardiac arrhythmias. J. Cardiov. Surg. 5: 212, 1964. MedlineGoogle Scholar15. HURSTPAULKPROCTORSCHLANT JWSAHDRC: Management of patients with atrial fibrillation. Amer. J. Med. 37: 728, 1964. CrossrefMedlineGoogle Scholar16. PANTRIDGEHALMOS JFPB: Conversion of atrial fibrillation by direct current countershock. Brit. Heart J. 27: 128, 1965. CrossrefMedlineGoogle Scholar17. ROBICSEKSANGERTAYLORMCCALLNAHIB FPWFHMA: Synchronized countershock: an adjuvant to surgical therapy. Angiology 14: 445, 1963. CrossrefMedlineGoogle Scholar18. MCDONALDRESNEKOVOBRIEN LLK: Direct-current shock in treatment of drug-resistant cardiac arrhythmias. Brit. Med. J. 1: 1468, 1964. CrossrefMedlineGoogle Scholar19. MORRISENTMANNORTHKONGMCINTOSH JJMWCYHD: The changes in cardiac output with reversion of atrial fibrillation to sinus rhythm. Circulation 31: 670, 1965. CrossrefMedlineGoogle Scholar20. ORAMDAVIESWEINBRENTAGGARTKITCHEN SJPIPLD: Conversion of atrial fibrillation to sinus rhythm by direct-current shock. Lancet 2: 159, 1963. CrossrefMedlineGoogle Scholar21. GRAETTINGERCARLETONMUENSTER JSRAJJ: Circulatory consequences of changes in cardiac rhythm produced in patients by transthoracic direct-current shock. J. Clin. Invest. 43: 2290, 1964. CrossrefMedlineGoogle Scholar22. KAHNWILSONWEBERSLOAN DRWSWH: Hemodynamic studies before and after cardioversion. J. Thorac. Cardiov. Surg. 48: 898, 1964. CrossrefMedlineGoogle Scholar23. GILBERTEICHSMULYANKEIGHLEYAUCHINCLOSS RRHHJJH: Effect on circulation of conversion of atrial fibrillation to sinus rhythm. Circulation 27: 1079, 1963. CrossrefMedlineGoogle Scholar24. MCINTOSHKONGMORRIS HDYJJ: Hemodynamic effects of supraventricular arrhythmias. Amer. J. Med. 37: 712, 1964. CrossrefMedlineGoogle Scholar25. BRAUNWALDFRAHM ECJ: Studies on Starling's law of the heart. IV. Observation on the hemodynamic functions of the left atrium in man. Circulation 24: 633, 1961. CrossrefGoogle Scholar26. FREEMANWEXLER IJ: Anticoagulants for treatment of atrial fibrillation. JAMA 184: 1007, 1963. CrossrefMedlineGoogle Scholar27. FERRERHARVEY MIRM: The value of converting atrial fibrillation to normal sinus rhythm. Amer. Heart J. 68: 725, 1964. CrossrefMedlineGoogle Scholar28. BLUMGART H: The reaction to exercise of the heart affected by auricular fibrillation. Heart 11: 49, 1924. Google Scholar29. KNOX JA: The heart rate with exercise in patients with auricular fibrillation. Brit. Heart J. 11: 119, 1949. CrossrefMedlineGoogle Scholar30. WETHERBEEBROWNHOLZMAN DGMGD: Ventricular rate response following exercise during auricular fibrillation and after conversion to normal sinus rhythm. Amer. J. Med. Sci. 223: 667, 1952. CrossrefMedlineGoogle Scholar31. GRAYBIEL A: Auricular fibrillation in an asymptomatic young man. Effects of exercise, digitalization, atropinization and the restoration of normal rhythm. Amer. J. Cardiol. 14: 828, 1964. CrossrefMedlineGoogle Scholar32. GOLDMAN MJ: The management of chronic atrial fibrillation: indications for and methods of conversion to sinus rhythm. Progr. Cardiov. Dis. 2: 465, 1960. CrossrefGoogle Scholar33. DALEYMATLINGLYHOLTBLANDWHITE RTWCLEFPD: Systemic arterial embolism in rheumatic heart disease. Amer. Heart J. 42: 566, 1951. CrossrefMedlineGoogle Scholar34. SHAVERKROETZTENICELALANCASTERLEONARD JAFWRJFJJ: Post cardio-version ventricular tachycardia. Presented at Fourteenth Annual Convention, American College of Cardiology, Boston, Mass., February, 1965. Google Scholar35. KATZZITNIK MJRS: Direct current countershock and lidocaine in the treatment of digitalis induced ventricular tachycardia. Ibid. Google Scholar36. PELEŠKA B: Cardiac arrhythmias following condenser discharges and their dependence upon strength of current and phase of cardiac cycle. Circ. Res. 13: 21, 1963. CrossrefMedlineGoogle Scholar37. GILBERTCUDDY RRP: Digitalis intoxication following conversion to sinus rhythm. Circulation 32: 58, 1965. CrossrefMedlineGoogle Scholar38. BAERWEGLARZKILLIP RST: Cardiac function in atrial fibrillation and sinus rhythm. Clin. Res. 12: 175, 1964. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: JAMES J. MORRISJR., M.D.; ROBERT H. PETER, M.D.; HENRY D. MCINTOSH, M.D., F.A.C.P.Affiliations: Durham, North CarolinaFrom the Cardiovascular Laboratory, Department of Medicine, Duke University Medical Center, Durham, N. C.This study was supported in part by grants HE-07563 and H-4807, the National Institutes of Health, Bethesda, Md., and by grants-in-aid from the North Carolina Heart Association and the Council for Tobacco Research—U. S. A.Dr. Morris was supported by a Special Fellowship and Dr. Peter by a Postdoctoral Fellowship from the U. S. Public Health Service, Washington, D. C., at the time of this work.Requests for reprints should be addressed to James J. Morris, Jr., M.D., Cardiovascular Laboratory, Duke University Medical Center, Durham, N. C. 27706. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited by2020 Clinical guidelines for Atrial fibrillation and atrial flutterCardiac ArrhythmiasTreatment of Atrial Fibrillation and Atrial FlutterReview: Atrial fibrillation and renin-angiotensin systemAntithrombotic Therapy in Atrial FibrillationSupraventricular Tachyarrhythmias in the ElderlyWhen, how, and why should sinus Rhythm be restored in patients with persistent atrial fibrillation?Prediction of sinus rhythm maintenance following DC-cardioversion of persistent atrial fibrillation – the role of atrial cycle lengthSerum troponin I level after external electrical direct current synchronized cardioversion in patients with normal or reduced ejection fraction: No evidence of myocytes injuryProspective, randomized comparison of two biphasic waveforms for the efficacy and safety of transthoracic biphasic cardioversion of atrial fibrillationAntithrombotic Therapy in Atrial FibrillationRate versus rhythm control in atrial fibrillationCardioversion électrique externe des troubles du rythme atriaux : critères prédictifs de succèsEmbolismo sistémico tras reversión a ritmo sinusal del aleteo auricular persistenteAtrial FibrillationEffects of chronic atrial fibrillation on gap junction distribution in human and rat atriaElectrical cardioversion preceded by TEE was no more effective than a conventional strategy of cardioversion but did prevent hemorrhagic eventsRole of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillationGuías de práctica clínica de la Sociedad Española de Cardiología en arritmias cardíacasAntithrombotic Therapy in Atrial FibrillationPilsicainide for conversion and maintenance of sinus rhythm in chronic atrial fibrillation: A placebo-controlled, multicenter studyMANAGEMENT OF ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIAS AND PACEMAKERS IN OLDER PERSONS: Series Editor: Wilbert S. Aronow, MD: Management of the Older Person With Atrial FibrillationResource Utilization in Atrial FibrillationLow Energy Internal Atrial Cardioversion in Atrial Fibrillation Lasting More Than a YearTiming of thromboembolic events after electical cardioversion of atrial fibrillation or flutter: a retrospective analysisAntithrombotic Therapy in Atrial FibrillationThe peri‐operative management of atrial fibrillationAcute Treatment of Atrial Fibrillation: Why and When to Maintain Sinus RhythmCriteria for Selection of Patients for Internal Atrial Defibrillator ImplantationsThromboembolism in Chronic Atrial Flutter: Is the Risk Underestimated?Use of cardiac troponin t rapid assay in the diagnosis of a myocardial injury secondary to electrical cardioversionVerapamil Reduces Tachycardia-Induced Electrical Remodeling of the AtriaEffect of Electrode Position on Outcome of Low-Energy Intracardiac Cardioversion of Atrial FibrillationPain Threshold for Low Energy Intracardiac Cardioversion of Atrial Fibrillation with Low or No SedationPrediction of Outcome of Electrical Cardioversion by Left Atrial Appendage Flow Velocities in Atrial FibrillationTransesophageal echocardiography-guided approach to cardioversion of atrial fibrillationInternal Cardioversion in Two Patients with Atrial Fibrillation Refractory to External CardioversionInternal atrial defibrillation and implantable atrial defibrillatorsAtrial Fibrillation Begets Atrial FibrillationAntithrombotic Therapy in Atrial FibrillationLimitations of transesophageal echocardiography in the risk assessment of patients before nonanticoagulated cardioversion from atrial fibrillation and flutter: An analysis of pooled trialsInitial Experience with Intracardiac Atrial Defibrillation in Patients with Chronic Atrial FibrillationShould all patients undergo transesophageal echocardiography before electrical cardioversion of atrial fibrillation?Usefulness of transesophageal echocardiography to screen for left atrial thrombus before elective cardioversion for atrial fibrillationEffectiveness of Amiodarone and electrical cardioversion for chronic rheumatic atrial fibrillation after mitral valve surgeryTime-course of recovery of atrial contraction after cardioversion of chronic atrial fibrillationInternal cardioversion of atrial fibrillation in sheep.Antithrombotic Therapy in Atrial FibrillationLow energy conversion of atrial fibrillation in the sheepManagement of Atrial FibrillationRole of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutterTransesophageal low-energy synchronous cardioversion of atrial flutter/fibrillation in the dogCardiac ArrhythmiasRisk and Prevention of Embolism in Atrial FibrillationDrugs after Cardioversion to Prevent Relapses of Chronic Atrial Fibrillation or FlutterPrediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutterLow energy synchronous transcatheter cardioversion of atrial flutter/fibrillation in the dogTherapy of refractory symptomatic atrial fibrillation and atrial flutter: a staged care approach with new antiarrhythmic drugsNew hope in atrial fibrillationPractical management of atrial fibrillationFactors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatationAnticoagulation for cardioversion of atrial fibrillationAntithrombotic Therapy in Atrial FibrillationEchocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillationDoppler echocardiographic predictors of recurrence of atrial fibrillation after cardioversionLong-term oral propafenone therapy for suppression of refractory symptomatic atrial fibrillation and atrial flutterChronic Atrial FibrillationNeurological complications of cardiovascular therapySupraventricular tachyarrhythmias: Their evaluation and therapyIntracavitary electrode catheter cardioversion of atrial tachyarrhythmias in the dogAntithrombotic Therapy in Atrial FibrillationAmiodarone for refractory atrial fibrillationFactors affecting tolerance to digitalisDiltiazem, Verapamil, and Quinidine in Patients With Chronic Atrial FibrillationDiltiazem, Verapamil und Chinidin als Mono- und Kombinationstherapie bei chronischem VorhofflimmernElective cardioversion in the presence of conduction disturbancesRecent advances in cardiopulmonary resuscitation and defibrillationMyocardial infarction following electrical injuryCardioversion of atrial fibrillation: Consideration of embolization, anticoagulation, prophylactic pacemaker, and long-term successCardioversion and defibrillationTermination of Atrial Flutter and Atrial Tachycardia With Rapid Atrial StimulationMyocardial Necrosis from Direct Current CountershockElectric control of the heartElectric control of the heartPERICARDITIS FOLLOWING CARDIOVERSIONRefractory Supraventricular TachycardiasQuinidine and countershock: A reappraisalRapid atrial stimulation: Successful method of conversion of atrial flutter and atrial tachycardiaPulmonary Edema after Direct Current CountershockFACTORS INFLUENCING PERSISTENCE OF SINUS RHYTHM AFTER DC SHOCK TREATMENT OF ATRIAL FIBRILLATIONMONOPHASIC ACTION POTENTIAL AND SINUS RHYTHM STABILITY AFTER CONVERSION OF ATRIAL FIBRILLATIONPulmonary Edema following Direct Current CardioversionTreatment of Cardiac ArrhythmiasThe use of drugs in achieving successful DC cardioversionThe efficacy of anticoagulant therapy in preventing embolism related to D.C. electrical conversion of atrial fibrillationEnzyme changes following direct current countershockA Clinical Profile of Idiopathic Atrial Fibrillation A Functional Disorder of Atrial RhythmROBERT H. PETER, JACK G. GRACEY, THOMAS B. BEACHLactic dehydrogenase isoenzymes after electroshock treatment of cardiac arrhythmiasDIRECT CURRENT CONVERSION OF ATRIAL FIBRILLATION-LONG-TERM RESULTSAN EVALUATION OF DC SHOCK TREATMENT OF ATRIAL ARRHYTHMIASDIRECT CURRENT COUNTERSHOCK COMPLICATIONSFactors affecting cardioversion of atrial arrhythmias with special reference to quinidine.Case 49-1967Recognition of Digitalis Intoxication in the Presence of Atrial FibrillationJOHN A. KASTOR, M.D., PETER M. YURCHAK, M.D., F.A.C.P.Pulmonary edema following cardioversion 1 August 1966Volume 65, Issue 2Page: 216-231KeywordsAtrial fibrillationFellowshipsHemodynamicsIntoxicationLongitudinal studiesMedical servicesOintmentsResearch laboratoriesShockStenosis ePublished: 1 December 2008 Issue Published: 1 August 1966 PDF downloadLoading ...