Author + information
- Theodore Richards JR,
- Mandar Jagtap,
- Frank McGrew,
- Tejaswi Munagala,
- Linnea Lebaron,
- Dakshin Gangadharamurthy and
- Likhitesh Jaikumar
Double Sequential External Defibrillation(DSED) is a rarely used but often successful technique utilized in cases of refractory atrial fibrillation when standard direct current cardioversion utilizing a single external defibrillator fails to restore normal sinus rhythm. The technique involves placing the first set of defibrillator pads in the typical apex-sternum orientation while the second set is placed in the anterior-posterior position. Then two separate defibrillators are charged to their maximum output and discharged simultaneously. This frequently results in successful conversion to normal sinus rhythm.
We report a 56 year old obese white female with history of ischemic cardiomyopathy and paroxysmal atrial fibrillation. She has previously had successful rhythm control with a combination of oral amiodarone therapy and one remote previous direct current cardioversion. She presents to clinic in atrial fibrillation with chief complaint of fatigue and dyspnea. Patient underwent a TEE guided cardioversion. The cardioversion was performed in the usual fashion however after multiple unsuccessful shocks at 360 jules the patient remained in atrial fibrillation. DSED was performed using 360 jules from each device for a combined total of 720 jules. The patient converted with one shock into normal sinus rhythm. She tolerated the procedure well and has remained in sinus rhythm.
Some patients require aggressive rhythm control for their atrial fibrillation because they do not tolerate the arrhythmia. While there are multiple pharmaceutical treatment options available, these become limited in the setting of structural heart disease as in our patient. Unsuccessful cardioversion can be a very frustrating scenario for both the patient and the physician.
DSED is a treatment option that is rarely used but should remain in our “tool box” for difficult cases of refractory atrial fibrillation. Historically it has been used more commonly in the treatment of ventricular arrhythmias, but can be successfully utilized for atrial fibrillation as well.
Posters Hall_Hall A
Sunday, March 29, 2020, 10:00 a.m.-10:45 a.m.
Session Title: FIT Clinical Decision Making: Arrhythmias and Clinical EP 4
Abstract Category: Arrhythmias and Clinical EP
Presentation Number: 1279-295
- 2020 American College of Cardiology Foundation