Short-Term Blood Pressure Response to Electric Cardioversion

David Shimony Internal Medicine, Shaarey Zedek Hospital, Jerusalem, Israel Benjamin Mazouz Internal Medicine, Shaarey Zedek Hospital, Jerusalem, Israel Cardiology, Shaarey Zedek Hospital Giora Weisz Internal Medicine, Shaarey Zedek Hospital, Jerusalem, Israel Cardiology, Shaarey Zedek Hospital Michael Glikson Internal Medicine, Shaarey Zedek Hospital, Jerusalem, Israel Cardiology, Shaarey Zedek Hospital Sharon Einav Internal Medicine, Shaarey Zedek Hospital, Jerusalem, Israel Intensive Care Unit, Shaarey Zedek Hospital

Introduction. Electric CardioVersion (ECV) is an accepted method to restore NSR in patients with atrial fibrillation (AF). We conducted a prospective study to assess optimal peri-cardioversion management. We assessed success rates, biochemical, electro-physical and hemodynamic data. Here, we report the short term Blood-Pressure (BP) response to ECV. Our null hypothesis was that there would be no difference or an increase in BP post ECV as is observed in the treatment of rapid AF with low BP.

Methods:

Consecutive patients were included if they were in AF, hemodynamically stable, agedā‰„18, and needed ECV. Most were treated by anti-arrhythmic drugs. Cardioversion was performed by a cardiologist, who selected energy to deliver. Protocol-based sedation was managed by an anesthesiologist. Zoll (R series) defibrillators with the ability to broadcast the entire process to a dedicated server were used. This allowed post-hoc analysis of real-time data.

Results:

127 patients were included, 49% were male, the median age was 75 yo. The most common background disease was hypertension (82.6%) and 40% had diabetes mellitus. Treatment for hypertension included Beta Blockers (BB), angiotensin-converting-enzyme inhibitors (ACE-I) and Calcium Chanel Blockers (CCB). Pre procedure BP was measured on average 22:46 (median 18:24) min before the ECV. Post procedure BP measurement was taken on average 09:03 (median 05:31) min after ECV. Post procedure mean systolic and diastolic pressure were statistically significantly lower than pre procedure values, on average 20 mmHg lower (median differences 19 and 22 mmHg respectively, Wilcoxon signed rank test two tailed P value<0.001). Moreover, mean arterial pressure (MAP) decreased in a similar manner post procedure in patients both with and without hypertension (mean change in MAP 21.7 vs. 21.3, T-test P value=0.99). This decrease in BP was not accompanied by hypoxemia

Discussion:

Unlike unstable patients with rapid ventricular response who increase BP after ECV, we observed that in stable patients who underwent ECV, BP dropped significantly post ECV. The response was persistent among patients with or without hypertension . BP decrease could not be explained by anesthesia (which was standardized) nor by drugs (the drop was observed in those with and without anti-hypertensive therapy).

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