Feasibility and efficacy of electrical cardioversion after cardiac resynchronization implantation in patients with permanent atrial fibrillation

Purpose

Patients with permanent atrial fibrillation (AF) who undergo cardiac resynchronization therapy (CRT) may spontaneously recover sinus rhythm during follow-up. We tested the feasibility and efficacy of electrical cardioversion attempted after 3?months of CRT in patients with permanent AF and measured the long-term maintenance of sinus rhythm.

Methods

Twenty-eight consecutive patients with permanent AF in whom CRT defibrillators had been implanted were scheduled for internal electrical cardioversion after 3 months (group A) and were compared with a control group of 27 patients (group B).

Results

In group A, 22 patients (79?%) were eligible for cardioversion; sinus rhythm was restored in 18 (82?%) of these, with no procedural complications. After 12?months, 16 patients (58?%) in group A were in sinus rhythm, compared with one group B patient who spontaneously recovered sinus rhythm (4?%, p?p?=?0.018 versus baseline).

Conclusions

In patients with permanent AF, the rhythm control strategy consisting of internal cardioversion, performed by means of the implanted cardioverter?Cdefibrillator after 3?months of CRT, was associated with a high rate of sinus rhythm resumption on long-term follow-up and with a better echocardiographic response to CRT than that seen in patients treated according to a rate control strategy.