Atrial Arrhythmia
Conditions
Brief summary
Arrhythmias of the atria of the heart are a common comorbidity in patients with cardiac rhythm management devices, such as pacemakers and implantable cardioverter/defibrillators (ICD). External electrical cardioversion is an established method to achieve rhythm control (restore normal sinus rhythm) in patients with atrial arrhythmia. Little data on safety and efficacy of external electrical cardioversion in patients with cardiac rhythm management devices exists. Thus, available data on the safety of external electrical cardioversion in cardiac rhythm management patients lacks statistical power to accurately reflect the true hazard of external electrical cardioversion in patients with cardiac rhythm management devices. The aim is to systematically include and follow all patients with cardiac rhythm management devices presenting for external electrical cardioversion, to analyse the effects of external electrical cardioversion on leads and devices.
Detailed description
Introduction Atrial arrhythmias are a common comorbidity in patients with cardiac rhythm management (CRM) devices, such as pacemakers and ICD. External electrical cardioversion is an established method to achieve rhythm control in patients with atrial arrhythmia. A paucity of data on safety and efficacy of external electrical cardioversion in patients with cardiac rhythm management devices exists. Most publications are of older date and predominantly case reports or case collections. Few prospective studies with a population of cardiac rhythm management patients after external electrical cardioversion have been published in recent years. Thus, available data on the safety of external electrical cardioversion in cardiac rhythm management patients lacks statistical power to accurately reflect the true hazard of external electrical cardioversion in patients with cardiac rhythm management devices. Rationale Electrocardioversion in Propofol sedation for atrial or ventricular tachyarrhythmia is an established therapy. It is routinely used for patients with cardiac rhythm management devices and the risk of device and lead affectation is deemed to be low. This assumption is currently not supported by substantial and current scientific data, mostly relying on older reports. No large, prospective trials with a population of patients with modern cardiac rhythm management devices exists. Aim of the study The aim is to systematically include and follow all patients with cardiac rhythm management devices presenting for external electrical cardioversion, to analyse the effects of external electrical cardioversion on leads and devices. Thereby, providing reliable evidence and detecting possible SAE with a low incidence. Furthermore, to gather information on efficacy and recurrence rate in this population, to examine the value of external electrical cardioversion for rhythm control in these patients.
Interventions
PROCEDURECardioversion
Sponsors
Universitätsklinikum Köln
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Informed, written consent * Atrial or ventricular arrhythmia with indication for CV * Status post CRM implantation, including CRT-D
Exclusion criteria
* Age \< 18 years * Patients under guardianship or with mental disorders / disabilities * lead implantation \< 4 weeks prior to CV * contraindications for eCV or transoesophageal echocardiographie (TOE)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite safety endpoint: Changes of lead and device parameters | 2 weeks after CV | assessed by device interrogation, if any of the following criteria is met: * a rise in threshold (at constant pulse duration) of \>1V * exit block of any of the pacing leads * loss of programming of the device * rise in shock impedance by 50% * rise in charge time by 50% * drop in battery voltage of ≥0.2V within \< 6 weeks |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Late changes of lead parameters | 2 weeks after CV | Any of the below, assessed by device interrogation: * Lead impedance \> 1000 Ohm * a rise in lead impedance by 50% * ventricular lead sensing \< 2mV * atrial lead sensing \< 1mV |
| Inadvertent induction of ventricular fibrillation | 10 seconds after CV | Assessed by 3 lead monitoring ECG |
| Composite endpoint: Early lead changes | within 15 minutes after CV | assessed by device interrogation, if any of the following criteria is met: * a rise in threshold (at constant pulse duration) of \>1V * exit block of any of the pacing leads * Lead impedance \> 1000 Ohm * a rise in lead impedance by 50% * ventricular lead sensing \< 2mV * atrial lead sensing \< 1mV |
| Efficacy Endpoint | within 15 minutes after CV | Assessed by device interrogation and 12-lead ECG: \- restoration of normal sinus rhythm after CV |
| Change of shock impedance | within 15 minutes after CV | assessed by device interrogation: \- rise in shock impedance by 50% |
| Change of charge time | within 15 minutes after CV | assessed by device interrogation: \- rise in charge time by 50% |
| Loss of programming | within 15 minutes after CV | assessed by device interrogation: \- loss of programming of the device |
Countries
Germany
Contacts
Primary ContactJakob Lüker, Dr.
Outcome results
None listed