A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion.

Aim Low-energy (1 to 15 J), catheter-based intracardiac cardioversion was compared with transthoracic external cardioversion (360 J) in a prospective, cross-over clinical trial. Methods and results In 187 consecutive patients with chronic atrial fibrillation, over a period of a mean of 10·0±7·3 (SD) months, 217 cardioversion attempts were made. Intracardiac shocks were randomly applied between two 6-F catheters located in either the right atrium and coronary sinus or between the right atrium and left pulmonary artery. When a cardioversion attempt with one method failed, the other method was implemented. After cardioversion, all patients were treated orally with sotalol with a mean daily dose of 174±54 mg. Conclusion Internal cardioversion is effective in restoring sinus rhythm. It might be indicated in patients in whom external cardioversion had failed or in whom external cardioversion is assumed to be difficult or even contraindicated. [ABSTRACT FROM PUBLISHER]