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Electrical cardioversion of patients with implanted pacemaker or cardioverter–defibrillator: results of a survey of german centers and systematic review of the literature

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Abstract

Aims

A relevant number of patients presenting for electrical cardioversion carry a pacemaker (PM) or ICD. Case reports suggest a potential hazard of external cardioversion/defibrillation. The incidence of shock related device complications is unknown. No guidelines or recommendations by international medical societies for a cardioversion protocol of cardiovascular implantable electronic device (CIED) patients exist. We conducted a nationwide survey to gather real-world clinical data on the current clinical approach towards these patients during electrical cardioversion and to estimate the incidence of shock-related complications.

Methods and results

Ninety hospitals with > 380 ECV in 2014 were identified from mandatory hospital quality reports and 60 were randomly selected. All centers were provided with a standardized questionnaire on the general proceedings and complications during electrical cardioversion of pacemaker, ICD and CRT patients (CIED patients). Thirty-two centers (53%) participated in the survey. In total, 16,554 ECV were reported (534 ± 314 per center). Biphasic cardioversion with a first shock energy of ≥ 150 J via adhesive patches in antero-posterior orientation was preferred by most centers (78%). Eleven percent (n = 1809) of pts were reported to carry a PM/ICD. The ECV protocol was heterogeneous among centers. Complications associated with electrical cardioversion were reported in 11/1809 patients (0.6%), all were transitory elevations of pacing thresholds.

Conclusions

In this nationwide snapshot survey of cardioversion procedures in Germany, approximately 11% of patients presenting for elective electrical cardioversion were pacemaker or ICD carriers. Cardioversion protocols in these patients are heterogeneous throughout centers and mostly not in accordance with recommendation of the German Cardiac Society. Complications associated with external electrical cardioversion are rare. Controlled trials and large registries are necessary to provide evidence for future recommendations.

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Abbreviations

CIED:

Cardiovascular implantable electronic device

ECV:

Electrical cardioversion

ICD:

Implantable cardioverter-defibrillator

PM:

Pacemaker

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Authors and Affiliations

  1. Department of Electrophysiology, University Hospital Cologne, Cologne, Germany

    J. Lüker, A. Sultan, T. Plenge, J. van den Bruck & D. Steven

  2. Department of Cardiology, Asklepios Klinik St.Georg, Hamburg, Germany

    C.-H. Heeger

  3. Department of Cardiology, Hospital Oldenburg, Oldenburg, Germany

    S. Meyer

  4. Department of Cardiology, University Hospital Aachen, Aachen, Germany

    K. Mischke

  5. Department of Cardiology, University Hospital Lübeck, Lübeck, Germany

    R. R. Tilz

  6. Herz- & Gefäßzentrum Göttingen, Göttingen, Germany

    D. Vollmann

  7. Clinic for Cardiology, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany

    G. Nölker

  8. Department of Electrophysiology, University Heart Center, Hamburg, Germany

    B. Schäffer & S. Willems

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  1. J. Lüker
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  2. A. Sultan
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  3. T. Plenge
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  12. S. Willems
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  13. D. Steven
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Corresponding author

Correspondence to J. Lüker.

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Conflict of interest

J. Lüker: none declared, A. Sultan: none declared, T. Plenge: none declared, J. van den Bruck: none declared, C.-H. Heeger: none declared, S. Meyer: none declared, K. Mischke: none declared, R.R. Tilz: none declared, D. Vollmann: none declared, G. Nölker: none declared, B.Schäffer: none declared, S. Willems: none declared, D. Steven: none declared.

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Lüker, J., Sultan, A., Plenge, T. et al. Electrical cardioversion of patients with implanted pacemaker or cardioverter–defibrillator: results of a survey of german centers and systematic review of the literature. Clin Res Cardiol 107, 249–258 (2018). https://doi.org/10.1007/s00392-017-1178-y

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  • DOI: https://doi.org/10.1007/s00392-017-1178-y

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