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Jain P, Patel V, Patel Y, Rasool J, Gandhi SK, Patel P. Effectiveness of Transesophageal Echocardiography in Preventing Thromboembolic Complications Before Cardioversion: A Narrative Review. Cureus 2023; 15:e48149. [PMID: 38046740 PMCID: PMC10692994 DOI: 10.7759/cureus.48149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Atrial fibrillation (AFib) is one of the most prevalent irregular heartbeats that doctors encounter. Clinicians typically pursue two main approaches for treatment, namely, controlling the heart rate and managing the heart rhythm. Under the rhythm control approach, AFib is addressed through cardioversion, which is achieved either with medications termed pharmacological cardioversion (PCV) or via an electrical shock termed electric cardioversion (ECV). While ECV proves instrumental in AFib management, it carries its own risk factors, potentially leading to blood clot-related complications such as embolic strokes. To counteract this potential downside, a well-established strategy involves the utilization of transesophageal echocardiography (TEE) to identify possible embolic sources before initiating cardioversion. The goal of this systematic review is to highlight the role of TEE in preempting embolic occurrences following ECV during the management of AFib. After conducting a thorough search of databases, namely, PubMed, PubMed Central, and Medline, a total of 36 studies were selected for this review article. Following a comprehensive evaluation of these studies, it was concluded that TEE plays a pivotal role in preventing thromboembolic complications during ECV for AFib. However, it is important to note that further research is needed to delve deeper into this matter. While existing evidence underscores its efficacy, additional investigation is needed to address this subject matter comprehensively.
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Affiliation(s)
- Prateek Jain
- Department of Internal Medicine, Maulana Azad Medical College, Delhi, IND
| | - Vishwesh Patel
- Department of Internal Medicine, M.P. Shah Government Medical College, Jamnagar, IND
| | - Yashaswi Patel
- Department of Internal Medicine, Government Medical College, Surat, Surat, IND
| | - Jawairiya Rasool
- Department of Internal Medicine, Dow International Medical College, Karachi, PAK
| | | | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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Shah H, Hanna KS, Kaur H, Alazzeh MS, Thandavaram A, Channar A, Purohit A, Shrestha B, Patel D, Mohammed L. The Outcome of Electrical Cardioversion in Hyperthyroid Induced Atrial Fibrillation. Cureus 2023; 15:e37928. [PMID: 37220445 PMCID: PMC10200072 DOI: 10.7759/cureus.37928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Hyperthyroidism is a prevalent cause of atrial fibrillation (AF). High cardiac output with low systemic vascular resistance, driven by hyperthyroidism, is associated with a rapid heartbeat, enhanced left ventricular systolic and diastolic function, and a higher incidence of supraventricular tachyarrhythmias. After returning to euthyroid status, hyperthyroidism-induced AF generally spontaneously reverts to sinus rhythm (SR), and a significant number of patients remain in chronic AF and require electrical cardioversion (ECV). After effective cardioversion, the long-term outcome of hyperthyroidism-induced persistent AF is unknown. Early ECV before the antithyroid medication should be explored for hyperthyroidism-induced AF to reduce the risk of thromboembolic consequences. The recurrence rate of AF between Hyperthyroid and Euthyroid Patients after ECV did not significantly differ. This review article compares the recurrence rate of AF as an outcome of ECV in Hyperthyroid induced atrial fibrillation.
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Affiliation(s)
- Hriday Shah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kerollos S Hanna
- General Physician, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Harkirat Kaur
- General Physician, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammad S Alazzeh
- Orthopaedic Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abhay Thandavaram
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aneeta Channar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ansh Purohit
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bijay Shrestha
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Deepkumar Patel
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Ralli M, Justesen T, Frevert SC, Schultz ANØ. Traumatic iatrogenic chylothorax after external electrical cardioversion. Respirol Case Rep 2021; 9:e00695. [PMID: 33304593 PMCID: PMC7713552 DOI: 10.1002/rcr2.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/14/2020] [Indexed: 11/11/2022] Open
Abstract
Chylothorax, an uncommon cause of pleural effusion, results from the accumulation of lymph in the pleural space due to damage or obstruction of the thoracic duct. Chylothorax can be due to several aetiologies, many of which are rare, and it is often a diagnostic challenge to identify the cause. This case report refers to a patient with rapid recurrent episodes of bilateral pleural chylothorax due to damage of the thoracic duct after external electrical cardioversion treatment. The diagnosis took place by the method of exclusion, when all known causes of chylothorax, both non-traumatic and traumatic, were ruled out. A review of the literature on chylothorax was performed using PubMed to assess the different aetiologies, investigations, and treatments usually performed. Chylothorax is usually secondary to malignancy, trauma, congenital diseases, and infections. However, even non-invasive thoracic procedures, such as the one described in our case report, can be the cause.
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Affiliation(s)
- Maria Ralli
- Department of Internal MedicineHospital Southern JutlandSonderborgDenmark
| | - Tobias Justesen
- Department of Internal MedicineHospital Southern JutlandSonderborgDenmark
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Karapanagiotidis GT, Gukop PS, Zakkar M, Tossios P, Leventis F, Ntontos G, Sarsam MAI. Combination of internal (epicardial) and external (transthoracic) defibrillation during heart surgery. Indian J Thorac Cardiovasc Surg 2020; 36:163-165. [PMID: 33061118 DOI: 10.1007/s12055-019-00882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/17/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022] Open
Abstract
Objectives This report describes a modified defibrillation technique during cardiac surgery using a combined internal (epicardial) and external (transthoracic) defibrillation system. Methods We routinely used 30 J (J) shock between the epicardial pad placed directly onto the right atrium and the left anterolateral transthoracic pad placed in the left anterolateral chest wall directly to the skin in the area of the cardiac apex under the nipple. Results Thirty-two patients whom developed ventricular fibrillation (VF) during surgery were managed in theatre using this method. A single 30 J shock was successfully given in 29 patients while the remaining three required an additional shock with the same amount (30 J). Conclusions We believe that this technique is safe and complications free. It is easy to perform especially in patients with difficult access such as redo operations.
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Affiliation(s)
- Georgios Theodoros Karapanagiotidis
- Cardiothoracic Surgery Department, St George's Hospital, Blackshaw Road SW, Tooting, London, 17 0QT UK.,Cardiothoracic Surgery Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Philemon Sylvester Gukop
- Cardiothoracic Surgery Department, St George's Hospital, Blackshaw Road SW, Tooting, London, 17 0QT UK
| | - Mustafa Zakkar
- Cardiothoracic Surgery Department, St George's Hospital, Blackshaw Road SW, Tooting, London, 17 0QT UK
| | - Paschalis Tossios
- Cardiothoracic Surgery Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Fotios Leventis
- Cardiothoracic Surgery Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Georgios Ntontos
- Cardiothoracic Surgery Department, AHEPA University Hospital, Thessaloniki, Greece
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Sunman H, Aytemir K, Yorgun H, Canpolat U, Yalçin MU, Maharjan N, Asil S, Şahiner L, Kaya B, Özer N, Oto A. Evaluating the Efficacy and Safety of Internal Cardioversion with Implantable Cardioverter Defibrillator Device for Atrial Fibrillation in Systolic Heart Failure Patients. Ann Noninvasive Electrocardiol 2015; 21:181-8. [PMID: 26084862 DOI: 10.1111/anec.12282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/19/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) commonly observed in patients with heart failure and cardioversion was often needed to restore the sinus rhythm. Previously, there is no study evaluating usefulness of internal cardioversion with implantable cardioverter defibrillator (ICD) device. In this study, we aimed to compare the efficacy and long-term effects of internal cardioversion with ICD devices compared to conventional external cardioversion in patients with AF and heart failure. METHODS Seventy patients with AF and heart failure who underwent electrical cardioversion were enrolled in the study. Forty patients (mean age 65.36 ± 10.37, 35 male) were assigned to undergo internal cardioversion with approximately 35 J shocks delivered through the ICD electrode. Standard external cardioversion was performed for the remaining patients (30 patients; mean age 66.20 ± 11.89; 24 male) that were similar with regard to baseline, and electrocardiographic characteristics. RESULTS Sinus rhythm was restored in 32 of 40 patients (80.0%) assigned to internal cardioversion compared with 25 of 30 patients (83.3%) assigned to external cardioversion (P = 0.725). We did not witness any serious complication during the procedure and hospitalization. On the follow-up, there was no statistically significant difference in recurrence of AF and incidence of major cardiovascular events between the internal and external cardioversion groups. CONCLUSIONS Internal cardioversion with ICD device is an effective and safe method to restore sinus rhythm in heart failure patients with AF.
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Affiliation(s)
- Hamza Sunman
- Department of Cardiology, Ministry of Health Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Muhammet Ulvi Yalçin
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Naresh Maharjan
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Levent Şahiner
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Barış Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Necla Özer
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Ali Oto
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
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