Simultaneous double external DC shocks technique for the refractory atrial fibrillation

Atrial fibrillation (AF) has been treated with DC shocks delivered transthoracically but in 5-30 % of patients, the procedures fail to restore sinus rhythm (SR). In this study we evaluated the efficacy of higher energy for the treatment of refractory AF with using synchronized double external defibrillator. Between the 1.1.1998-1.3.2000, standard DC CV were performed in 240 patients in our hospital. 15 patients (mean age 65+/-8) with refractory AF to standard DC CV underwent higher energy DC shock with using double external cardioverter. Structural heart disease was present in all patients Amiodarone 600 mg/day, and digoxine were administered at least three weeks before DC CW. All patients were anticoagulated. Before procedures all patients were sedatized with iv. midazolam. Two defibrillator patch were positioned the anterior and posterior chest wall on right lateral decubitus position. Defibrillators were synchronized to R wave and simultaneously 720 joule energy were administered to patients. SR were obtained in 12 patients. Amiodarone (200 mg/day) was continuously administered after DC CV. Sinus rhythm was persistent after I months in II patients. Creatine kinase CK-MB fraction were normal after 4. hours (18+/-4 iu/L) and 12. hours (22+/-4 iu/L) None of the patients developed significant hemodynamic compromise or congestive heart failure, higher AV block, stroke or transient ischemic cerebral events. There is a few clinical study for the DC CV of refractory atrial fibrillation synchronized double external defibrillator especially in patients with structurally heart disease. We thought that this methods is effective and safe for the DC CV of refractory AF and must be performed before internal atrial cardioversion.