Eficacia y seguridad de la cardioversión eléctrica ambulatoria en la fibrilación auricular persistente

work objective despite new findings in the treatment of atrial fibrillation, electrical cardioversion keeps playing an important role, which raises the need of simplifying the procedure itself. the purpose of the present analysis was to evaluate the risks and benefits of ambulatory electrical cardioversion in a heterogeneous cohort of patients with persistent atrial fibrillation. research design and methods one hundred and seventy six consecutive patients with persistent atrial fibrillation were enrolled between february 2000 and september 2003. ambulatory electrical cardioversion was performed. the protocol consisted of monophasic current shocks with increasing energy (200 j, 300 j, 360 j) in the anterior position and when unsuccessful, 360 j in the anteroposterior position, previous sedo-analgesia with propofol and fentanyl. patients were discharged two hours after the procedure and were followed up during a year. results mean age was 66 years, 73% were male, 67% had structural heart disease and 59% had a history of atrial fibrillation before the event. the average length of atrial fibrillation was 21 weeks and the average inr was 2.21. seventy percent of patients received treatment with class iii antiarrhythmics. the procedure was successful in 85% of the patients (n = 150), with an average number of 1.34 shocks and an accumulated energy of 277.95 j per patient. three patients developed post-procedure congestive heart failure and seven patients had transient bradiarrhythmias at less than 40 beats per minute. conclusion ambulatory electrical cardioversion is an effective and safe method for the treatment of persistent atrial fibrillation.