What is the clinical evidence from this study?

Study design: Case Report. Population: Persistent atrial fibrillation (n=4). Intervention: Dual-device direct current cardioversion (dual DCCV). Primary outcome: Conversion to sinus rhythm after dual DCCV.

May 11, 2026Open Access

Implementation of dual-device direct current cardioversion to restore sinus rhythm during hybrid antiarrhythmic cardiac surgery for persistent atrial fibrillation: A case series and insights from the hybrid operating room

Key Result

Dual direct current cardioversion successfully restored sinus rhythm in all 4 patients with persistent atrial fibrillation who failed single cardioversion immediately following thoracoscopic ablation.

Study Design

Type

Case Report (n=4)

Multicenter

Structured PICO

Does dual direct current cardioversion restore sinus rhythm in patients with persistent atrial fibrillation who fail single cardioversion immediately after thoracoscopic ablation?

Population

4 adults (age 34-61 years, 3 men, 1 woman) with refractory persistent atrial fibrillation who underwent totally thoracoscopic surgical ablation and failed a single, optimized synchronized single direct current cardioversion (DCCV) attempt (200-J biphasic) immediately postoperatively.

Intervention

Dual direct current cardioversion (DCCV) using 2 defibrillators set to SYNC mode, delivering simultaneous 200-J biphasic shocks at end-expiration via nonoverlapping anterior-posterior and apical-right parasternal pad pairs.

Outcome

Conversion to sinus rhythm (SR) after dual DCCV and SR at discharge.

Dual DCCV is a feasible and acutely effective rescue strategy for restoring sinus rhythm in patients with persistent atrial fibrillation who fail standard single DCCV immediately after thoracoscopic ablation.

Limitations

Small sample size
Single-center design
Lack of long-term data
No control group
Transthoracic impedance and current delivered were not measured
Selection bias from including only patients failing initial single DCCV
Device synchronization and myocardial effects were not systematically assessed

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Cite This Study

Rykowski et al. (Wed,) conducted a case report in Persistent atrial fibrillation (n=4). Dual-device direct current cardioversion (dual DCCV) was evaluated on Conversion to sinus rhythm after dual DCCV. Dual direct current cardioversion successfully restored sinus rhythm in all 4 patients with persistent atrial fibrillation who failed single cardioversion immediately following thoracoscopic ablation.

synapsesocial.com/papers/6a025f00c9581ed855361b5b https://doi.org/https://doi.org/10.33963/v.phj.112510

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