Öz

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<0,001). It was shown that a biphasic shock waveform has greater efficacy, requires lower delivered energy in AF patients, than a monophasic waveform for conversion to sinus rhythm. As a sequel, it is more appropriate using biphasic shock waveform defibrillators for ECV.

Atriyum Fibrilasyonu Hastalarında Bifazik ve Monofazik Dalga Formuyla Kardiyoversiyonun Karşılaştırılması

Öz

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<0,001).  AF li hastalarda EKV için bifazik dalga formu kullanılmasının, monofazik dalga formu kullanılmasına göre daha düşük enerji kullanıldığı ve SR sağlamada daha başarılı olduğu gözlenmiştir. Bu nedenle AF li hastalarda EKV işleminde bifazik defibrilatörlerin kullanılmasının daha doğru bir yaklaşım olacağını düşünmekteyiz.

Anahtar Kelimeler

• kardiyoversiyon,atriyal fibrilasyon,bifazik,monofazik

Kaynakça

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