An evaluation of the relative success of internal and external electrical cardioversion of atrial arrhythmias in adults, including a comparison of single and dual coil lead devices

Abstract

Introduction: Although there is a high prevalence of atrial arrythmias in patients with cardiovascular implantable electronic devices (CIED), few studies have compared the efficacy of cardioversion modalities for the restoration of sinus rhythm. The primary aim of this study is to compare the efficacy of internal and external first-time cardioversion for the treatment of atrial arrythmias in patients with an implantable cardioverter defibrillator (ICD), including the relative efficacy of dual and single coil leads.

Methods: Demographic and clinical information was collected and analysed from consecutive electronic records of patients with a CIED who received atrial cardioversion at a single NHS trust between 2008 and 2023. Non-parametric statistical analyses were undertaken to enable the relative success of first-time cardioversion for different modalities to be determined.

Results: 163 patients were identified, of which 71 received external and 92 received internal cardioversion. External cardioversion had the highest first-time efficacy (90.1%) with a statistically significant difference in first-time success between the external and combined internal cohorts (p=.002). Dual coil leads had superior first-time efficacy (80.4%) compared to single coil leads (56.1%), with a statistically significant difference between them (p=.022).

Conclusions: First-time internal cardioversion success is superior for patients with dual coil leads compared to single coil leads. There is no statistical difference between first time success for dual coil internal and external cardioversions, making an initial attempt at internal cardioversion a potentially credible clinical option for patients with dual coil leads.

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