Some patients with atrial fibrillation may be successfully resuscitated electrically, but are highly susceptible to recurrence after the procedure, and those who cannot maintain a normal rhythm should not be electrically resuscitated. Whether a patient with atrial fibrillation needs to be electrically resuscitated must be evaluated comprehensively and selected appropriately.
In general, those who meet the following conditions can be considered for electrical cardioversion.
(1) The patient is young in age.
(2) Short history of atrial fibrillation (usually less than 1 year).
(3) The heart is not significantly enlarged (cardiothoracic ratio generally does not exceed 55%).
(4) Atrial fibrillation with rapid ventricular rate and difficult to control by medication.
(5) Those with heart failure or worsening angina pectoris after the occurrence of atrial fibrillation and difficult to control with drugs.
(6) Atrial fibrillation with controlled primary disease, such as hyperthyroidism, rheumatic heart disease after mitral valve stenosis surgery, etc.
(7) Patients with rheumatic heart disease who have insignificant left atrial enlargement (generally left atrial internal diameter <45mm) and compensated cardiac function.
(8) In patients with mitral stenosis in rheumatic heart disease who still have atrial fibrillation after valve separation or replacement, it is generally advocated to perform electrical resuscitation after 3 months after surgery. This is because the degree of recovery from surgical trauma and the degree of reduction of the enlarged left atrium can affect the efficacy of electrical resuscitation. (9) Pre-excitation syndrome with atrial fibrillation, when drug therapy is ineffective, can be resuscitated by electric shock.
2, contraindications
(1) Long history of atrial fibrillation.
(2) Significantly enlarged heart, or those with a large left atrium.
(3) Severe cardiac insufficiency.
(4) Elderly patients whose ventricular rate can be controlled with drugs.
(5) Digitalis toxicity.
(6) Atrial fibrillation with high atrioventricular block.
(7) Tachycardia-bradycardia syndrome.
(8) Drugs that must be taken to maintain a normal rhythm after reentry, such as quinidine, are not tolerated.
(9) Those who have had electrical resuscitation in the past, but relapsed soon after.
(10) Severe electrolyte disturbance or acid-base balance disorder that has not been corrected.
(11) Active rheumatic disease.
(12) Recent thromboembolic disease.
(13) Those who are preparing for recent surgery.
(14) Active pericardial disease.
(15) Active myocarditis.
(16) Decompensated pulmonary disorders.
(17) Primary atrial fibrillation with poor efficacy of electrical resuscitation.
(18) Transient episodes of atrial fibrillation. Atrial fibrillation electrical resuscitation is selective electrical resuscitation, which requires strict patient selection, good preoperative preparation and simultaneous electrical resuscitation under anesthesia.