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.
Kaynakça
- Geraets DR, Kienzle MG. Atrial fibrillation and atrial flutter. Clin Pharm. 1993;12:721-735; quiz 783-724.
- Cairns JA, Connolly SJ. Nonrheumatic atrial fibrillation. Risk of stroke and role of antithrombotic therapy. Circulation. 1991;84:469-481.
- 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.
- 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.
- Laupacis A, Albers G, Dalen J, Dunn MI, Jacobson AK, Singer DE. Antithrombotic therapy in atrial fibrillation. Chest. 1998;114:579S-589S.
- 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.
- 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-of-hospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation. 2000;102:1780-1787.
- 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.
- 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;101:1282-1287.
- 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.
- 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.
- 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.
- 13. 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;48:854-906.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Lown B, Kleiger R, Wolff G. The Technique of Cardioversion. Am Heart J. 1964;67:282-284.
- 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.
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
Kaynakça
- Geraets DR, Kienzle MG. Atrial fibrillation and atrial flutter. Clin Pharm. 1993;12:721-735; quiz 783-724.
- Cairns JA, Connolly SJ. Nonrheumatic atrial fibrillation. Risk of stroke and role of antithrombotic therapy. Circulation. 1991;84:469-481.
- 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.
- 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.
- Laupacis A, Albers G, Dalen J, Dunn MI, Jacobson AK, Singer DE. Antithrombotic therapy in atrial fibrillation. Chest. 1998;114:579S-589S.
- 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.
- 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-of-hospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation. 2000;102:1780-1787.
- 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.
- 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;101:1282-1287.
- 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.
- 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.
- 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.
- 13. 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;48:854-906.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Lown B, Kleiger R, Wolff G. The Technique of Cardioversion. Am Heart J. 1964;67:282-284.
- 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.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | ORİJİNAL MAKALELER / ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 2 Nisan 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 40 Sayı: 2 |