927–31 Effect of Sotalol on Transvenous Atrial Defibrillation for Acute and Chronic Atrial Fibrillation

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.109A-109A
• Main Authors: Sang, Lok Ngai, Pak, Lau Chu, Wai, Tang Yuen, Wah David, Ho Sai
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)91905-D

Transvenous atrial defibrillation (IADF) is a recently developing technique for converting atrial fibrillation (AF) to sinus rhythm. Adjunctive antiarrhythmic therapy is likely to be used to maintain sinus rhythm. To evaluate the effects of sotalol on transvenous ADF for AF. R wave synchronized, biphasic (3ms + 3ms), truncated exponential shocks were delivered between decapolar catheters in the right atrium and the coronary sinus at increasing voltages (between 20V to 380V, in steps of 40V) until sinus rhythm returned or maximum voltage achieved. Sustained AF was reinduced with atrial pacing, intravenous sotalol (1.5mg/kg) was given and ADF was repeated. Twenty one patients with chronic AF (mean duration of 15±16 months) and 11 patients with AF induced during electrophysiologic study underwent ADF. The mean age was 49±8 years, 56±9 years and left atrial diameter was 3.5±0.5cm, 4.0±0.6cm (p=0.01) for acute and chronic AF, respectively. All except 3 and 2 patients were successfully cardioverted at baseline and after sotalol infusion, respectively. Sotalol maintained sinus rhythm in 4 patients in whom AF recurred within 10s after successful defibrillation at baseline.Acute AFBefore SotalolAfter sotalolP valueEnergy (J)2.6±1.71.9±1.50.05Post-shock RR (ms)1479±10312647±21060.07Mean pressure (mmHg)90±1680±110.03Chronic AFBefore SotalolAfter SotalolP valueEnergy (J)3.6±1.43.1±1.20.34Post-shock RR (ms)2291±14323160±17060.13Mean pressure (mmHg)104±2391±280.16 Transvenous ADF was effective in restoring sinus rhythm for both acute and chronic AF, sotalol lowered the defibrillation energy and may have important implications in reducing pain sensation and maintaining sinus rhythm during ADF. Transvenous ADF was more effective in restoring sinus rhythm in acute AF than in chronic AF (100% vs 85.7%, p<0.001), and was achieved at a lower defibrillation energy.