Ahmet DOKSÖZ, Gurbet Özge MERT, KADİR UĞUR MERT

Atriyum Fibrilasyonu Hastalarında Bifazik veya Monofazik Dalga Formuyla Kardiyoversiyonun Karşılaştırılması

Atriyum fibrilasyonu hastalarında kardiyoversiyon işlemi farmakolojik veya elektriki olarak uygulanabilir. Elektriki kardiyoversiyonda (EKV) bifazik dalga formu kullanılması, monofazik dalga kullanılmasına göre daha düşük enerji gerektirdiği ve daha yüksek sinüs ritmine (SR) döndürme oranı tespit edilmiştir. Biz de AF ritmini SR’ne döndürmede kullanılan elektriki kardiyoversiyon işleminde monofazik dalga formu veya bifazik dalga etkinliğini karşılaştırmak amacıyla çalışma planladık. Çalışmaya 48 saatten daha uzun süreli atriyum fibrilasyonu ritminde olduğu tespit edilen, elektriki kardiyoversiyon endikasyonu konmuş 50 hasta dahil edilmiştir. Kardiyoversiyon işlemi transtorasik antero-lateral yerleştirilen elektrotlarla monofazik veya bifazik dalga formuyla yapıldı. Çalışmaya alınan hastaların yaş ortalaması 64,8 ± 10,5 ve 50 hastanın 22’si erkekti. Bifazik dalga formlu defibrilatörle yapılan kardiyoversiyonun SR sağlamadaki başarısı monofazik dalga formlu defibrilatörlere göre daha yüksek saptanmakla birlikte istatistiki olarak anlamlı değildi. Hastalara verilen kümülatif enerji düzeyleri monofazik dalga formu ile EKV uygulanan olgularda 682±462 joule, bifazik dalga formu ile EKV uygulanan olgularda 234±211 joule olarak saptandı (p

Comparison of Biphasic or Monophasic Waveform Cardioversion in Patients with Atrial Fibrillation

Cardioversion could be performed pharmacological or D/C electrical (ECV) in patients with atrial fibrillation. A biphasic shock waveform has greater efficacy, requires lower delivered energy, than a monophasic waveform for conversion of AF to sinus rhythm. We aimed to evaluate efficacy of a biphasic shock waveform in comparison with a monophasic shock waveform ECV for conversion of AF to sinus rhythm. We enrolled 50 patients with atrial fibrillation more than 48 h. who were decided to perform electrical cardioversion therapy. Cardioversions were performed transthoracic antero-lateral position of the paddles with a monophasic shock waveform or a biphasic shock waveform. Mean age was 64,8 ± 10,5 in our study population and 22 of them was male. A biphasic shock waveform has greater efficacy than a monophasic shock waveform for conversion of AF to sinus rhythm without any statistical significance. Cumulative delivered energy was 682±462 joule in monophasic shock waveform group, and was 234±211 joule in biphasic shock waveform group (p

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Toso E, Iannaccone M, Caponi D, Rotondi F, Santoro A, Gallo C, Scaglione M, Gaita F. Does antiarrhythmic drugs premedication improve electrical cardioversion success in persistent atrial fibrillation? J Electrocardiol. 2017 May -Jun; 50(3):294-300.
Singh BN, Singh SN, Reda DJ, Tang XC, Lopez B, Harris CL, et al. For the sotalol amiodarone atrial fibrillation efficacy trial (SAFE-T) investigators* amiodarone versus sotalol for atrial fibrillation. Med 2005;352:1861–72.
Channer KS, Birchall A, Steeds RP, Walters SJ, Yeo WW, West JN, et al. A randomized placebocontrolled trial of pre-treatment and short- or long term maintenance therapy with amiodarone supporting DC cardioversion for persistent atrial fibrillation. Eur Heart J 2004;25:144–50.
Elhendy A, Gentile F, Khandheria BK, Hammill SC, Gersh BJ, Bailey KR, et al. Facilitating transthoracic cardioversion of atrial fibrillation with ibutilide pretreatment. Med 1999;340:1849–54.
Vitor S. Kawabata, Caio B. Vianna, Miguel A. Moretti, Maria M. Gonzalez, João F. Ferreira, Sergio Timerman, Luiz A. Cesar; Monophasic versus biphasic waveform shocks for atrial fibrillation cardioversion in patients with concomitant amiodarone therapy, Europace, 2007; 9:143–146.
Mortensen K, Risius T, Schwemer TF, Aydin MA, Köster R, Klemm HU, Lutomsky B, Meinertz T, Ventura R, Willems S. Biphasic versus monophasic shock for external cardioversion of atrial flutter: a prospective, randomized trial. Cardiology. 2008;111(1):57-62
Alihanoğlu Yİ, Kılıç Dİ, Yıldız BS. Cardioversion and defibrillation. Pam Med J 2015;8(2):156-164.
Deakin CD, Ambler JJ. Post-shock myocardial stunning: a prospective randomised double-blind comparison of monophasic and biphasicwaveforms. Resuscitation 2006;68:329-333.
Botto GL, Politi A, Bonini W, Broffoni T, Bonatti R. External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements. Heart. 1999;82:726-730.
Lown B, Kleiger R, Wolff G. The Technique of Cardioversion. Am Heart J. 1964;67:282-284.
Chen PS, Shibata N, Dixon EG, et al. Activation during ventricular defibrillation in open-chest dogs. Evidence of complete cessation and regeneration of ventricular fibrillation after unsuccessful shocks. J Clin Invest. 1986;77:810-823.
Witkowski FX, Penkoske PA, Plonsey R. Mechanism of cardiac defibrillation in open-chest dogs with unipolar DC-coupled simultaneous activation and shock potential recordings. Circulation. 1990;82:244-260.
Platia EV, Michelson EL, Porterfield JK, Das G. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol. 1989;63:925-929.
Suttorp MJ, Kingma JH, Jessurun ER, Lie AHL, van Hemel NM, Lie KI. The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. J Am Coll Cardiol. 1990;16:1722-1727.
Suttorp MJ KJ, Lie AH, Mast EG. Intravenous flecainide versus verapamil for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. Am J Cardiol 1989;63:693– 696
Borgeat A, Goy JJ, Maendly R, Kaufmann U, Grbic M, Sigwart U. Flecainide versus quinidine for conversion of atrial fibrillation to sinus rhythm. Am J Cardiol. 1986;58:496-498.
Glover BM, Walsh SJ, McCann CJ, et al. Biphasic energy selection for transthoracic cardioversion of atrial brillation. The BEST AF Trial. Heart 2008;94:884-887
Alt E, Ammer R, Schmitt C, et al. A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion. Eur Heart J. 1997;18:1796-1804.
Clinical competence in elective direct current (DC) cardioversion. A statement for physicians from the ACP/ACC/AHA Task Force on Clinical Privileges in Cardiology. J Am Coll Cardiol. 1993;22:336-339.
Fuster V, Ryden LE, Cannom DS, 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). J Am Coll Cardiol. 2006;48:854906.
de Denus S, Sanoski CA, Carlsson J, Opolski G, Spinler SA. Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis. Arch Intern Med. 2005;165:258-262.
Gurevitz OT, Ammash NM, Malouf JF, et al. Comparative efficacy of monophasic and biphasic waveforms for transthoracic cardioversion of atrial fibrillation and atrial flutter. Am Heart J. 2005;149:316-321.
Page RL, Kerber RE, Russell JK, et al. Biphasic versus monophasic shock waveform for conversion of atrial fibrillation: the results of an international randomized, double-blind multicenter trial. J Am Coll Cardiol. 2002;39:1956-1963.
Mittal S, Ayati S, Stein KM, et al. Transthoracic cardioversion of atrial fibrillation: comparison of rectilinear biphasic versus damped sine wave monophasic shocks. Circulation. 2000;101:12821287.
Mittal S, Ayati S, Stein KM, et al. Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation. ZOLL Investigators. J Am Coll Cardiol. 1999;34:1595-1601.
Schneider T, Martens PR, Paschen H, et al. Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-ofhospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation. 2000;102:1780-1787.
Niebauer MJ, Brewer JE, Chung MK, Tchou PJ. Comparison of the rectilinear biphasic waveform with the monophasic damped sine waveform for external cardioversion of atrial fibrillation and flutter. Am J Cardiol. 2004;93:1495-1499.
Laupacis A, Albers G, Dalen J, Dunn MI, Jacobson AK, Singer DE. Antithrombotic therapy in atrial fibrillation. Chest. 1998;114:579S-589S.
Arnold AZ, Mick MJ, Mazurek RP, Loop FD, Trohman RG. Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol. 1992;19:851-855.
Lip G. How would I manage a 60 year old woman presenting with atrial fibrillation? . Proceedings of the Royal College of Physicians of Edinburgh 1999;29:301–306.
Cairns JA, Connolly SJ. Nonrheumatic atrial fibrillation. Risk of stroke and role of antithrombotic therapy. Circulation. 1991;84:469-481.
Geraets DR, Kienzle MG. Atrial fibrillation and atrial flutter. Clin Pharm. 1993;12:721-735; quiz 783-724.