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PubMed1991

Incidence and clinical significance of ST segment elevation after electrical cardioversion of atrial fibrillation and atrial flutter.

To study the incidence and clinical significance of postshock ST segment elevations, we recorded 12-lead ECGs immediately after transthoracic direct-current electrical cardioversion in 146 patients with atrial fibrillation or flutter. Among 23 patients (19%), acute ST segment elevations amounted to 1.4 +/- 0.8 mV (mean +/- SD) and occurred after 243 +/- 114 joules (cumulative dose) in the precordial leads only in 14, concomitantly in precordial and inferior leads in two, and in the precordial and anterolateral leads in seven. They normalized within 1.5 +/- 0.8 minutes. Occurrence of ST segment elevation was related to previous pericardiotomy (p less than 0.00001) and age (p = 0.01). Estimation of myocardial enzyme release did not show evidence of myocardial damage. Patients with ST segment elevations had a lower conversion rate (48% versus 76%, p = 0.005). Long-term maintenance of sinus rhythm was also diminished (35% versus 59%, p = 0.03). Results of this study show that postcardioversion ST segment elevation occurs predominantly in postpericardiotomy patients and may be associated with an unfavorable arrhythmia prognosis.

Age Factors↗
PubMed1987

[Fibrillation and atrial flutter. Immediate control and conversion to sinus rhythm with intravenous propafenone].

The safety and efficacy of intravenous Propafenone, in the treatment of atrial fibrillation (a.f.) or flutter (A.F.) of recent onset (15 days), were assessed. Propafenone (2 mg/kg) was administered to 36 consecutive patients (mean age 60.8 years), 28 with a.f. and 8 with A.F. Nineteen patients (52.7%) reverted to sinus rhythm within 85 min (mean 27.2 min): 17 of 28 (60.7%) with a.f. and 2 of 8 (25%) with A.F. The efficacy of the drug was significantly influenced by the time elapsed from the onset of the arrhythmia: 14/21 (66.6%) patients with the arrhythmia lasting less then 48 hours and only 5/15 (33.3%) of those with the arrhythmia lasting more than 48 hours or of unknown onset, were converted (p less than 0.05). 18 patients underwent echocardiographic control: mean left atrial dimensions were 41.4 +/- 11.4 mm in converters and 47.4 +/- 11.2 mm in non converters (p = NS). Mean QRS lengthening observed was 16% (from 89 +/- 35.1 to 103.5 +/- 48.8 msec) (p = NS); QTc interval increased from 390 +/- 64.3 to 403 +/- 36.2 msec (p = NS). Arterial blood pressure showed significant changes only in two patients in whom a serious hypotension developed, needing infusion of adrenergic drugs. Non converters showed a reduction of the ventricular rate from 141.8 +/- 29.4/min to 101.8 +/- 18/min (p less than 0.01) meanwhile the shortest RR interval increased from 359.5 +/- 60.8 to 450 +/- 81.5 msec (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗