Treatment of Cardiac Arrhythmias with Synchronized Electrical Counter-shock

Synchronized electrical countershock is an intriguing new method for the treatment of ectopic tachycardias. The authors applied this treatment to 20 patients with chronic atrial fibrillation and, in 17 patients, sinus rhythm was restored immediately. An additional four patients with atrial flutter were successfully converted to sinus rhythm. One patient developed a hemiplegia two weeks after cardioversion. No other untoward side effects were observed. In two patients with ventricular fibrillation electrical countershock terminated the arrhythmia. After successful cardioversion of atrial fibrillation, a maintenance dose of quinidine is given to help maintain sinus rhythm. In spite of this precaution, one-half of the patients reverted to atrial fibrillation within a month. The quinidine was administered for two to three days in advance of cardioversion; on this regimen, 10 of 34 patients reverted to sinus rhythm on quinidine alone and did not require countershock. The exact place of this treatment of cardiac arrhythmias has not yet been clearly defined.