18. Atrial Fibrillation: Electrical Cardioversion and Drug Prophylaxis: 18.4 Clinical Application of Low-Energy Transesophageal Cardioversion of Atrial Fibrillation and Flutter

24 consecutive patients (12 F), age 51 – 88 yrs (mean 66,8) with paroxysmal (80%) or persistent atrial fibrillation and flutter. A special electrode was inserted in esophagus in a depth of 30 – 35cm using ECG control. An external electrode was placed in V₁ position. Pts were sedated with fentanyl and midazolam. The 1–3 DC shocks of energy 5 – 30J were performed using biphasic Zoll M-Series defibrillator.

Transesophageal cardioversion (TEC) was successful in 21 (87,5%) pts. A total amount of energy for patient was 5–65J (mean 21,36J), mean value of last impulse 14,5J. In 11 pts sinus rhythm restored with single shock of 5–20J (mean 10J). 8 pts required 2 shocks of total energy 15–50J (mean 22,5J). In 3 pts 3 shocks were applied of total energy 40 – 65 (mean 52,5J).

TEC is very successful in pts with atrial arrhythmias to restore sinus rhythm with the use of less energy. Further studies are needed to determine optimal energy of the first shock, and lowest energy dose. The procedure is well tolerated despite lack of general anesthesia.