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Toxicon 2018 Jun 31;148:33-39. Epub 2018 Mar 31.

Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.

A 42-year-old previously healthy male patient died 16 days after a proven hump-nosed pit viper (Hypnale hypnale) envenoming due to multi-organ failure. On admission he had cardiac arrest that recovered from cardiopulmonary resuscitation then developed atrial fibrillation which was reverted to normal rhythm by application of synchronized electrical cardioversion. He also had persistent coagulopathy and thrombotic microangiopathy comprising the triad of microangiopathic haemolysis, acute kidney injury and thrombocytopenia. Read More

BMC Cardiovasc Disord 2018 03 13;18(1):51. Epub 2018 Mar 13.

Department of Cardiology, Wenzhou People's Hospital, Wenzhou, Zhejiang Province, 325000, China.

Background: Atrial fibrillation (AF) usually originates from pulmonary veins (PVs) but can also be caused by pulmonary veins outside, such as the coronary sinus (CS), the superior vena cava (SVC), and the ligament of Marshall.

Case Presentation: A 69-year-old male with a history of palpitations for 10 years was referred to our institute because of its recurrence for half a day. A dynamic electrocardiogram revealed sinus rhythm (SR) and paroxysmal AF. Read More

Circ Arrhythm Electrophysiol 2017 Dec;10(12)

From the Nora Eccles Harrison Cardiovascular Research and Training Institute (N.P., R.R., D.J.D.), Division of Cardiothoracic Surgery, Department of Surgery (D.J.D.), and Division of Cardiovascular Medicine, Department of Medicine (L.L., R.R., D.J.D.), University of Utah, Salt Lake City; and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (J.H., R.E.I.).

Background: Understanding the mechanisms that drive ventricular fibrillation is essential for developing improved defibrillation techniques to terminate ventricular fibrillation (VF). Distinct organization patterns of chaotic, regular, and synchronized activity were previously demonstrated in VF that persisted over 1 to 2 minutes (long-duration VF [LDVF]). We hypothesized that activity on the endocardium may be driving these activation patterns in LDVF and that unsuccessful defibrillation shocks may alter activation patterns. Read More

Vet Clin North Am Small Anim Pract 2017 Sep 20;47(5):977-988. Epub 2017 Jun 20.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853-6401, USA. Electronic address:

A rate control, or a rhythm control, strategy can be applied to the management of atrial fibrillation. Rate control of atrial fibrillation consists of decreasing the ventricular response rate by limiting the number of supraventricular impulses that can travel through the atrioventricular node. The goal of decreasing heart rate in dogs with atrial fibrillation is usually achieved with a combination of the calcium channel blocker diltiazem and digoxin. Read More

Ann Emerg Med 2018 Jan 27;71(1):109-112. Epub 2017 May 27.

Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR.

The simultaneous use of 2 external defibrillators to administer either dual or sequential cardioversion or defibrillation for refractory cardiac arrhythmias is increasing in both the out-of-hospital and inhospital settings. Using 2 defibrillators to administer higher energy levels than can be achieved with a single defibrillator is considered off-label and is currently not part of published advanced cardiac life support guidelines. We report the first case in which the use of dual-dose cardioversion was associated with external defibrillator damage. Read More

Am J Cardiol 2017 06 29;119(12):1997-2002. Epub 2017 Mar 29.

Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China.

Use of the antiarrhythmic ibutilide after isolated pulmonary vein isolation (PVI) might distinguish atrial remodeling severity and cases requiring further substrate modification, thereby improving efficacy of persistent atrial fibrillation (AF) treatment. Ninety-six consecutive patients with persistent AF were randomized after PVI to either direct current synchronized cardioversion (DCC group, n = 48) or 1 mg of intravenous ibutilide (ibutilide group, n = 48) followed by no further intervention if AF converted to sinus rhythm (SR) within 30 minutes (ibutilide conversion subgroup) or by complex fractionated atrial electrogram (CFAE) ablation until SR recovery or complete CFAE elimination (ibutilide nonconversion subgroup). With similarly distributed baseline characteristics and no serious postablation complications, the primary end point of 12-month SR maintenance rate after PVI was significantly higher for ibutilide versus the DCC group before (75% vs 56%; p = 0. Read More

Curr Med Res Opin 2017 08 8;33(8):1497-1504. Epub 2017 Jun 8.

a First Department of Cardiology , Hippokration Hospital, University of Athens , Athens , Greece.

Background: Atrial fibrillation (AF) constitutes a relatively infrequent pregnancy complication, which may be a therapeutic Gordian knot. Indeed, sparse data exist regarding the prevalence, prognosis, and management of AF during pregnancy. In general, AF occurs as a benign, self-limited arrhythmia, but occasionally may have severe hemodynamic consequences in pregnant patients suffering from heart failure, congenital heart disease, or other comorbidities. Read More

PLoS One 2017 28;12(3):e0174510. Epub 2017 Mar 28.

Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China.

Objective: To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC) in patients with persistent atrial fibrillation (AF) and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation.

Methods: From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF) <50%) underwent DCC followed by amiodarone (n = 40) or circumferential pulmonary vein isolation (PVI; n = 57) according to patient's preference were recruited in the study. Read More

J Pediatr 2017 02 29;181:177-182.e2. Epub 2016 Nov 29.

Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address:

Objective: To characterize the management of acute pediatric supraventricular tachycardia (SVT), placing special emphasis on infants, patients refractory to adenosine (refractory SVT), and patients with hypotension, poor perfusion, or altered mental status (unstable SVT).

Study Design: Retrospective cohort study of patients 0-18 years of age without congenital heart disease who presented to our pediatric hospital from January 2003 to December 2012 for the treatment of acute SVT. Multiple logistic regression was applied to identify whether age was a risk factor for different SVT therapies. Read More

CJEM 2017 Jul 13;19(4):312-316. Epub 2016 Sep 13.

*Department of Internal Medicine,Jena University Hospital,Jena,Germany.

Atrial fibrillation (AF) is a frequent reason for emergency department visits. According to current guidelines either rate- or rhythm-control are acceptable therapeutic options in such situations. In this report, we present the complicated clinical course of a patient with AF and a rapid ventricular response. Read More

PLoS One 2016 9;11(9):e0162245. Epub 2016 Sep 9.

Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC, Canada.

Background: Previous serological studies have shown controversial results whether defibrillation or cardioversion can cause myocardial injury. Cardiovascular Magnetic Resonance (CMR) can be used to detect myocardial edema, hyperemia and capillary leak as features of acute myocardial injury. The aim of this study was to assess for myocardial and skeletal muscle injury in swine following transthoracic shocks. Read More

Arq Bras Cardiol 2016 Feb 26;106(2):84-91. Epub 2016 Jan 26.

Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.

Background: Atrial fibrillation (AF) is the most common arrhythmia in adults, and is encountered in 10-15% of the patients with hyperthyroidism. Unless euthyroidism is restored, pharmacological or electrical cardioversion is controversial in patients with AF who remain hyperthyroid.

Objective: The aim of this study was to assess the efficacy of electrical cardioversion and predictors of AF recurrence in hyperthyroid and euthyroid patients. Read More

Crit Care Med 2015 Nov;43(11):2354-9

1Cardiosurgical Intensive Care Unit, Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. 2Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. 3Epidemiology, Biostatistics and Prevention Institute (EBPI), Department of Biostatistics, University of Zurich, Zurich, Switzerland.

Objectives: To assess the success of electrical cardioversion for the treatment of new-onset atrial fibrillation in critically ill patients and to evaluate the stability of sinus rhythm in responders during the subsequent 24 hours.

Design: Retrospective study.

Setting: Twelve-bed cardiosurgical ICU at a university hospital. Read More

Biomed Res Int 2015 1;2015:840356. Epub 2015 Jul 1.

Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.

Background: Heart rate monitoring is especially interesting in patients with atrial fibrillation (AF) and is routinely performed by ECG. A ballistocardiography (BCG) foil is an unobtrusive sensor for mechanical vibrations. We tested the correlation of heartbeat cycle length detection by a novel algorithm for a BCG foil to an ECG in AF and sinus rhythm (SR). Read More

Masui 2014 Oct;63(10):1106-10

We report a case of paroxysmal supraventricular tachycardia (PSVT) that occurred during video-assisted thoracoscopic (VATS) lobectomy in a patient with concealed Wolff-Parkinson-White (WPW) syndrome. A 59-year-old man with lung cancer was scheduled for VATS lobectomy under general anesthesia. After inserting a thoracic epidural catheter, general anesthesia was induced with intravenous administration of propofol. Read More

Prehosp Emerg Care 2015 Jul-Sep;19(3):448-50. Epub 2015 Feb 9.

Early defibrillation for cardiac arrest patients is a formidable link in the chain of survival promulgated by the American Heart Association. Automated external defibrillators (AEDs) provide public access defibrillation for out-of-hospital cardiac arrests and improve survivability. AEDs are only approved for use in patients in cardiac arrest; defibrillation may be inadvertently advised if utilized on a patient not experiencing cardiac arrest. Read More

J Vet Cardiol 2014 Dec 7;16(4):277-81. Epub 2014 Oct 7.

Michigan State University, College of Veterinary Medicine, East Lansing, MI, USA.

Atrial fibrillation is a common arrhythmia in dogs with structural cardiac disease and can result in significant clinical signs. Several methods of electrical cardioversion of atrial fibrillation have been described. Biphasic transthoracic cardioversion of atrial fibrillation in dogs with naturally occurring heart disease has been described in veterinary medicine and has been shown to be highly successful. Read More

Heart Rhythm 2015 Jan 29;12(1):195-201. Epub 2014 Aug 29.

Heart Research Follow-up Program, Cardiology Department, University of Rochester Medical Center, University of Rochester, New-York.

Background: It is estimated that 33.5 million people in the world have developed atrial fibrillation (AF), and an estimated 30% of patients with AF are unaware of their diagnosis (silent AF).

Objective: The purpose of this study was to test a new technology for contactless detection of AF based on facial video recordings. Read More

AACN Adv Crit Care 2014 Jan-Mar;25(1):20-2

Serena Phromsivarak Kelly is Nurse Practitioner, Pediatric Intensive Care Unit, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon. Patricia Shoun is Staff Nurse, Pediatric Intensive Care Unit, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon. Joanne Mikol is Staff Nurse, Pediatric Intensive Care Unit, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon. Robert Steelman is Associate Professor, Pediatric Critical Care Medicine/Anesthesiology, Oregon Health & Science University, 700 SW Campus Dr, Portland, OR 97239

Indian J Pediatr 2014 Apr 15;81(4):413-4. Epub 2013 Sep 15.

Department of Neonatology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, 42080, Turkey,

J Emerg Med 2013 Nov 9;45(5):e149-51. Epub 2013 Aug 9.

Department of Emergency Medicine, Navy Medical Center San Diego, San Diego, California.

Background: Cardiac dysrhythmias after electrical injury have been reported previously, however, atrial fibrillation after low-voltage electrical injury is extremely rare. We present a case of atrial fibrillation with rapid ventricular response resulting from a low-voltage electrical injury.

Case Report: A 24-year-old active duty Navy sailor presented to the emergency department after an electrical shock from a 440-V furnace. Read More

J Int Med Res 2013 Aug 21;41(4):1067-73. Epub 2013 Jun 21.

Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China.

Objective: To compare the efficacy of electrical versus pharmacological cardioversion following prosthetic cardiac valve replacement in patients with permanent atrial fibrillation (AF).

Methods: Patients with permanent AF who had undergone prosthetic cardiac valve replacement, who had a cardiothoracic ratio ≤ 0.5 and a left atrial diameter ≤ 50 mm for ≥ 6 months after surgery were randomly divided to receive either electrical or pharmacological cardioversion. Read More

Prehosp Disaster Med 2013 Jun 14;28(3):301-4. Epub 2013 Mar 14.

Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.

Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of supraventricular tachycardia (SVT - either atrio-ventricular nodal reentry tachycardia (AVNRT) or atrio-ventricular reentrant tachycardia (AVRT)) with poor perfusion. The evidence is extremely limited with regard to the safety and effectiveness of this therapy. In Australia, half of the eight ambulance services include SDC within their clinical practice guidelines for the management of poorly perfused SVT; however the degree of variation in the application of SDC across these guidelines suggests a need to quantify the practice. Read More

Pediatrics 2013 Mar 4;131(3):e934-8. Epub 2013 Feb 4.

Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, WA 98105-0371, USA.

A healthy 14-year-old presented to an emergency department in Alaska, complaining of shortness of breath, chest pain, and 72 hours of malaise and headache. On admission, her blood pressure was 80/50 mm Hg, and she had cool extremities. Electrocardiography revealed wide-complex ventricular tachycardia. Read More

Case Rep Emerg Med 2012 12;2012:393275. Epub 2012 Jun 12.

Department of Emergency Medicine, The Ohio State University Medical Center, 750 Prior Hall, 376 W 10th Avenue, Columbus, OH 43210, USA.

We report on a case of a patient with atrial fibrillation in the setting of Wolff-Parkinson-White syndrome. The patient underwent synchronized electrical cardioversion, typically considered safe and effective, which resulted in a dangerous complication for the patient (degeneration into ventricular fibrillation). Discussion of common rhythm disturbances in WPW and management strategies are reviewed. Read More

Resuscitation 2013 Mar 27;84(3):286-91. Epub 2012 Jul 27.

Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.

Background: Several different biphasic waveforms are used clinically, but few studies have compared their efficacy. The two main waveforms are the biphasic rectilinear (BR) and biphasic truncated exponential (BTE) waveforms, both of which have important differences, particularly at the extremes of transthoracic impedance.

Objective: To compare the efficacy of two commonly used defibrillation waveforms in the elective cardioversion of atrial fibrillation. Read More

Ann Emerg Med 2012 Jul 11;60(1):67-70. Epub 2012 Jan 11.

Emergency Department, Ospedale Civile Maggiore, Azienda Ospedaliera di Verona, Verona, Italy.

We report a case of dyspnea in a 71-year-old man who underwent heterotopic heart transplantation in 2003. At presentation, electrocardiography showed ventricular fibrillation of the native heart and then a progression to both donor and recipient hearts. Synchronized electrical cardioversion restored sinus rhythm and relieved the patient from his symptoms. Read More

Am J Case Rep 2012 9;13:33-5. Epub 2012 Mar 9.

Numune Research and Training Hospital, Department of Emergency, Ankara, Turkey.

Background: Pregnancy can precipitate cardiac arrhythmias not previously present in seemingly well individuals. Atrial and ventricular premature beats are frequently present during pregnancy and are usually benign. Supraventricular tachycardia and malignant ventricular tachyarrhythmias occur less frequently. Read More

Nihon Rinsho 2011 Apr;69(4):695-8

Engineering Department 2, Biomedical Instrument Technology Center, Nihon Kohden Corporation.

Guideline 2010 for cardiopulmonary resuscitation was released the other day. There is no big change in the use of a defibrillator. Asynchronous defibrillation is used as a therapy for VF and pulseless VT. Read More

J Atr Fibrillation 2010 Oct-Nov;3(3):295. Epub 2010 Oct 22.

Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy.

Pregnancy is accompanied by a variety of cardiovascular changes in normal women; all of these changes are thought to promote arrhythmogenesis. Atrial fibrillation is unusual during pregnancy and it can represent a benign, self-limited lone atrial fibrillation or can be hemodynamically significant in parturient with or without structural heart disease. Management of atrial fibrillation should be the same as in non-pregnant women, but requires faster intervention, even in patients with a normal heart function, and cautious use of medication to avoid harm to the fetus. Read More

J Pediatr Surg 2010 Aug;45(8):E13-6

Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo 01050-904, Brazil.

Unlabelled: Cardiac arrhythmias during central venous catheter (CVC) insertion are typically transient events with no hemodynamic repercussions. Pediatric reports on this condition are scarce and fail to describe potentially life-threatening complications.

Case: A 14-day-old boy was admitted to the pediatric intensive care unit presenting with septic shock. Read More

Resuscitation 2010 Jun 25;81(6):724-9. Epub 2010 Mar 25.

Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA.

Objective: Pauses for shock delivery in chest compressions are detrimental to the success of resuscitation and may be eliminated with the use of mechanical chest compressors. However, the optimal phasic relationship between mechanical chest compression and defibrillation is still unknown. We therefore undertook a study to assess the effects of timing of defibrillation in the mechanical chest compression cycle on the defibrillation threshold (DFT) using a porcine model of cardiac arrest. Read More

J Am Vet Med Assoc 2010 Mar;236(5):554-7

Veterinary Specialists Incorporated, Animal Heart Centers, 91 NE 6th St, Homestead, FL 33030, USA.

Case Description: 2 spayed female (8 and 9 years old) and 1 sexually intact male (6.5 years old) Boxers were treated because of sustained ventricular tachycardia by electrical cardioversion.

Clinical Findings: Physical examination of the 8-year-old female Boxer revealed tachycardia (heart rate, 250 beats/min), weak femoral pulses, pale mucous membranes, panting, and lethargy. Read More

Conf Proc IEEE Eng Med Biol Soc 2009 ;2009:3012-5

A defibrillator sync output signal connector provides an ECG synchronization signal that can be used by some defibrillators for the purpose of performing synchronized cardioversion [1]. This process is used to stop an abnormally fast heart rate or cardiac arrhythmia by the delivery of a therapeutic dose of electric current to the heart during the R-wave of the cardiac cycle. Timing the shock to the R-wave prevents the delivery of the shock during the vulnerable period of the cardiac cycle, which could induce ventricular fibrillation [2]. Read More

Kaohsiung J Med Sci 2009 Dec;25(12):675-9

Department of Emergency Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.

Accurate diagnosis of wide QRS complex tachycardia is difficult in emergent situations. According to the Advanced Cardiac Life Support (ACLS) tachycardia algorithm of the American Heart Association, immediate synchronized cardioversion should be applied to patients with wide QRS tachycardia with any evidence of hemodynamic instability. However, this may not be appropriate in all patients, especially those with idiopathic left ventricular tachycardia. Read More

Europace 2010 Jan;12(1):139-41

Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.

Cardiac resynchronization permits atrial-synchronized simultaneous pacing of both left and right ventricles in order to optimize mechanical contraction. In case of an atrial tachycardia, a VVI-'ventricular sense'-tracking modus can be programmed to maintain biventricular pacing. In this case report, we describe the use of this modus. Read More

Vet Anaesth Analg 2009 Jul;36(4):341-51

Faculty of Veterinary Medicine, Department of Surgery and Anaesthesia of Domestic Animals, Ghent University, Salisburylaan, Merelbeke, Belgium.

Objective: To examine the influence of direct current shock application in anaesthetized horses with atrial fibrillation (AF) and to study the effects of cardioversion to sinus rhythm (SR).

Study Design: Prospective clinical study.

Animals: Eight horses successfully treated for AF (transvenous electrical cardioversion after amiodarone pre-treatment). Read More

Cardiol J 2009 ;16(3):197-209

General Internal Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.

Heart failure continues to be a major public health problem with high morbidity and mortality rates, despite the advances in medical treatment. Advanced heart failure patients have severe persistent symptoms and a poor quality of life. Cardiac resynchronization therapy (CRT), an invasive therapy which involves synchronized pacing of both right and left ventricles, improves ventricular conduction delay and left ventricular performance. Read More

Taiwan J Obstet Gynecol 2008 Sep;47(3):327-9

Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.

Objective: To report a case of atrial fibrillation with rapid ventricular response occurring during pregnancy.

Case Report: A 35-year-old woman, gravida 3, para 1, abortus 1, with a history of persistent supraventricular arrhythmia, presented at 22 weeks' gestation. After adenosine administration, electrocardiography revealed atrial fibrillation with rapid ventricular response. Read More

Cases J 2008 Sep 12;1(1):152. Epub 2008 Sep 12.

Department of Cardiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece.

In this report we briefly describe a patient with a dual chamber implantable cardioverter defibrillator in the context of severe ischemic cardiomyopathy who developed persistent atrial fibrillation. After appropriate anticoagulation and under mild sedation the patient was successfully cardioverted to sinus rhythm after a programmed ventricular synchronized defibrillation using his defibrillator. Programmed internal cardioversion of persistent atrial fibrillation in patients who have an implantable cardioverter defibillator without atrial defibrillation capabilities could be an effective and safe therapeutic option. Read More

Rev Cardiovasc Med 2008 ;9(2):137-41

Division of Electrophysiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.

The transthoracic application of synchronized direct current cardioversion (DCC) is widely used to terminate atrial fibrillation, atrial flutter, and other supraventricular tachyarrhythmia. DCC is a highly effective method for acute restoration of sinus rhythm. Although DCC is a relatively safe and frequently performed procedure, data on potential side effects are very rarely reported in the literature. Read More

Resuscitation 2008 Oct 14;79(1):28-33. Epub 2008 Jul 14.

Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.

Objective: We tested the hypothesis that the frequency of shock success differs between initial and recurrent episodes of ventricular fibrillation (VF).

Methods: Out-of-hospital cardiac arrest patients presenting with VF from December 1996 to February 2007 defibrillated using an AED with a fixed-energy protocol (150 J) (Philips Medical Systems, Seattle, WA) were included for analysis. We defined shock success as termination of VF within 5s post-shock (either asystole or organized rhythm). Read More

J Electrocardiol 2008 Nov-Dec;41(6):662-4. Epub 2008 May 6.

Arrhythmia Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.

A 67-year-old woman with persistent atrial fibrillation presented for elective electrical cardioversion. The patient was cardioverted to normal sinus rhythm with a synchronized 150 joules (J) biphasic shock. Varying P-wave morphology suggesting intermittent interatrial block (IAB) was noted after the cardioversion on the rhythm strip. Read More

Conf Proc IEEE Eng Med Biol Soc 2007 ;2007:2591-4

Universidad Simón Bolívar, Caracas, Venezuela.

The objective of this study, was to investigate the effect of internal DC shocks on the atrial fibrillation frequency (AFF). AFF has previously been shown to predict the success and energy requirements in patients undergoing internal cardioversion (IC) of atrial fibrillation (AF). However the possibility that unsuccessful shocks during IC may influence the AFF has not been before studied. Read More

Conf Proc IEEE Eng Med Biol Soc 2006 ;1:4362-5

Dept. of Medicine, Cedars-Sinai Med. Center, Los Angeles, CA 90048, USA.

Ventricular fibrillation (VF) can be synchronized with a novel synchronized pacing technique (SyncP) using low-energy pacing pulses, which causes pace termination of VF. Synchronized pacing (SyncP) is defined as optical recording guided real-time detection and stimulation of spatiotemporal excitable gaps. In this paper, we investigate the effect of post-shock SyncP strategy on improvement of defibrillation efficacy. Read More

Pediatr Emerg Care 2007 Mar;23(3):176-85; quiz 186-9

Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA.

Supraventricular tachycardia (SVT) is the most common tachyarrhythmia that necessitates treatment in children. It is characterized by a rapid and regular heart rate, which generally exceeds 180 beats per minute in children and 220 beats per minute in adolescents. Supraventricular tachycardia results from conduction of electrical impulses along an accessory connection from the atrium to the ventricle (atrioventricular reentry tachycardias: orthodromic or antidromic) or conduction within the atrioventricular node (atrioventricular node reentry tachycardia). Read More

J Cardiovasc Electrophysiol 2007 Jul 28;18(7):740-9. Epub 2007 Mar 28.

Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center and David Geffen School of Medicine, UCLA, Los Angeles, California 90048, USA.

Introduction: A failed near-threshold defibrillation shock is followed by an isoelectric window (IEW) and rapid repetitive responses that reinitiate ventricular fibrillation (VF). We hypothesized that properly timed (synchronized) postshock pacing stimuli (SyncP) may capture the recovered tissues during the repetitive responses and prevent postshock reinitiation of VF, resulting in improved defibrillation efficacy.

Methods And Results: We explored the effect of postshock SyncP on defibrillation efficacy in isolated rabbit hearts (n = 12). Read More

Pacing Clin Electrophysiol 2007 Feb;30(2):182-7

Department of Cardiology, Patras University Hospital, 26500 Rion, Patras, Greece.

Background: Ventricular desynchronization imposed by permanent dual-chamber ventricular pacing (VDD) may compromise ventricular function.

Methods: We investigated the impact of background VDD pacing on the right and left ventricular (LV) function on 129 clinically stable outpatients (mean age 69 +/- 10) implanted chronically with a dual-chamber pacemaker or an automatic defibrillator by using echocardiographic techniques including tissue doppler imaging (TDI) and color M-mode (CMM) examinations, and B-type natriuretic peptide (BNP) measurements. Patients were divided into two groups of normal (n = 65) or impaired (n = 64) LV systolic function (ejection fraction 63 +/- 6% and 38 +/- 10%, respectively) according to clinical and echocardiographic criteria. Read More

Pacing Clin Electrophysiol 2006 Dec;29(12):1383-6

Pediatric Arrhythmia Service, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York, USA.

Background: Low-dose biphasic waveform cardioversion has been used for the termination of atrial arrhythmias in adult patients. The energy required for termination of atrial arrhythmias in pediatric patients is not known. The objective of this study is to determine the minimum energy required for successful external cardioversion of atrial arrhythmias in pediatric patients using biphasic waveform current. Read More