2 years ago. Federal government websites often end in .gov or .mil. Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. The fetal monitor Doppler transducer contains a transmitter, or signal source, and receiver. Shah A, Moon-Grady A, Bhogal N, Collins KK, Tacy T, Brook M, et al. Manage cookies/Do not sell my data we use in the preference centre. Miyoshi et al. The majority of fetal arrhythmias are premature contractions. A premature atrial contraction, or PAC, is by far the most common arrhythmia we see. These extra beats try to signal the AV node, which sometimes works (called "conducted") and sometimes does not (called . government site. Despite apparent improvement in signal interpretation, autocorrelation is still not a true measure of short-term variability. Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur SA, Manlhiot C, et al. BMJ Open. Stirnemann et al. With ventricular systole, the closure of the atrioventricular (AV) valves produces the first heart sound. Unable to display preview. Lippincott Company, D. N. Lebrun (2003) Analysis of neonatal heart rate variability and cardiac orienting responses. It is the process of signal conversion to FHR that differs. Int J Cardiol. Ueda K, Maeno Y, Miyoshi T, Inamura N, Kawataki M, Taketazu M, on behalf of Japan Fetal Arrhythmia Group, et al. With the evolution of autocorrelation in many of the newer monitors, great advances have been made in both signal quality and continuity. Fetal electrocardiography (ECG) does not provide beat-to-beat analysis by detecting the signal averaging of electrocardiographic complexes. Fetal heart arrhythmias and doppler ultrasound. Novii provides the opportunity to enhance your current Labor and Delivery monitoring experience. 2004;52:13847. A healthy fetus has a heartbeat of 120 to 160 beats per minute, beating at a regular rhythm. The proposed study will allow the investigators to evaluate . . Rebelo M, Macedo AJ, Nogueira G, Trigo C, Kaku S. Sotalol in the treatment of fetal tachyarrhythmia. PHONOCARDIOGRAPHICALLY DERIVED FETAL HEART RATE. Efficacy and Safety of Various First-Line Therapeutic Strategies for Fetal Tachycardias: A Network Meta-Analysis and Systematic Review. With older monitors, the quality of the Doppler-created FHR tracing is directly related to the orientation of the signal to the fetal heart, the amount of fetal movement, and the degree of constant attention by nursing personnel of maintaining an adequate signal while caring for the patient. Utilitarian Function : Shelter, clothing . 2006;25:47781. The overall incidence of malignant fetal arrhythmias, such as complete AV block and SVT, are relatively rare, found in 1:5000 pregnancies [5]. Instead of hearing a "thump-THUMP-thump-THUMP" rhythm, the doctor might hear "thump THUMP-THUMP thump." There are three types of fetal arrhythmias: Bradyarrhythmia: The heart rate is too slow. Stirnemann J, Maltret A, Haydar A, Stos B, Bonnet D, Ville Y. These arrhythmias do not represent an expression of the physiological behavior of the ANS. In one of these, the heart rate of the mother was obtained from a dead fetus. Background: Fetal mediastinal masses may be clinically asymptomatic or cause . Fetal bradycardias may be due to sinus bradycardia, blocked PACs, or high degree AV block [46]. This technique can readily identify atrial and ventricular systoles, and measure the PR interval [17]. As the fetal heart beats, closure of the valves may be detected by listening with a suitable stethoscope through the mothers abdominal wall. The intrauterine or neonatal mortality rate in hydropic fetuses treated with flecainide was much lower than that treated with digoxin (0% vs. 43%, P=0.06). Digoxin has been considered the first-line agent for the treatment of fetal SVT. Supraventricular Tachycardia (SVT) Complete Heart Block. In addition, the actual signal created by the fetal cardiac motion is greatly affected by the position and movement of the transducer with respect to the fetus. 1,7. Article Sustained fetal arrhythmias that predispose to the occurrence of hydrops fetalis, cardiac dysfunction or eventual fetal demise require active treatments. The prolonged episodes of sinus bradycardia can be caused by fetal distress as a result of fetal hypoxia and acidosis, long QT syndrome, and congenital sinus node dysfunction [34]. Postma AV, van de Meerakker JB, Mathijssen IB, Barnett P, Christoffels VM, Ilgun A, et al. J Perinat Med. Prog Pediatr Cardiol. Fetal MCG may reveal a strong association between AF and an accessory pathway [29]. Strizek et al. on Biom. The neonatal and overall survival rates for fetal bradyarrhythmia with structural heart disease were much higher, which were 66 and 48%, respectively. Artifact vs arrhythmia. The role of echocardiography in fetal tachyarrhythmia diagnosis. fetal arrhythmia vs artifact. It allows the simultaneous recording of Fetal Heart Rate (FHR), by means of a Doppler probe, and Uterine Contractions (UC), by means of an indirect pressure transducer. Terms and Conditions, Mller cells in eyes of 39 human fetuses (11-38 weeks of gestation, WOG) and 6 infants (5 died of abusive head trauma, AHT, aged 1-9 months) were immunohistochemically stained and investigated for spatial and temporal immunoreaction of nestin, CD44, collagen IX and GFAP, which are . An ECG signal consists of P, . Intensities of less than 100 mW/cm. After the pacing wire was advanced into the right atrium and subsequently the right ventricle, the pacing rate was set up at 140bpm. Fetal PVCs warrant close monitoring as they may develop into proxysmal ventricular tachycardias (VTs). Capuruo et al. AlSoufi M. Successful treatment of fetal tachycardia by sotalol. Kang SL, Howe D, Coleman M, Roman K, Gnanapragasam J. Foetal supraventricular tachycardia with hydrops fetalis: a role for direct intraperitoneal amiodarone. sharing sensitive information, make sure youre on a federal This research shows a way of developing a unique non-invasive and low-cost fetal arrhythmia diagnosis method and evaluated the learning model for evaluating the leave one out (LOO) cross-validation. Fetal bradycardia with either congenital heart defects or fetal hydrops significantly worsens their prognoses. Sridharan S, Sullivan I, Tomek V, Wolfenden J, kovrnek J, Yates R, et al. Among other causes, the fetal arrhythmia is accountable for a significant portion of such . Sustained fetal arrhythmias associated with major structural heart disorders, hydrops fetalis, and fetal heart failure warrant intrauterine pharmaceutical conversion of heart rhythm or early pacemaker implant in order to avoid fetal demise. The amplified electrical signal can also be used as a counting source for an FHR monitor. Intraumbilical administration of antiarrhythmic agents can be performed under ultrasound guidance, but with somewhat technical difficulty, especially when the fetus is in an unfavorable location. van der Heijden LB, Oudijk MA, Manten G, ter Heide H, Pistorius H, Freund MW. J Am Coll Cardiol. 1993;12:66971. Almost all arrhythmias fall into one of three categories: irregular, tachycardic, or bradycardic. According to an article in the Indian Pacing and Electrophysiology Journal , the normal fetal heart rate ranges between 110 and 160 beats . -stimulants, such as ritodrine, terbutaline, and salbutamol, and steroids have been reported to be effective transplacental treatments for fetal AV block, and they may increase fetal ventricular rate by 1020% and reverse hydrops as well. Lecture 11 Fetal Complications Stages of Labor Assessments Variations for NB Maternity Meds Medication Hints Psych Tips Operational Stages . Google Scholar. Ann Pediatr Cardiol. Clinical and genetic spectrum of neonatal arrhythmia in a NICU. In the third case, a heart rate recording thought to . Fetal monitoring interpretation. If maternal transplacental treatment fails, intraumbilical, intraperitoneal, or direct fetal intramuscular injection of antiarrhythmic agents can be attempted. Correspondence to Detection of some dropped or extra beats (arrhythmia) is fairly common, occurring in 1 to 2 percent of pregnancies. IEEE Trans.Biomed.Eng. Define an intervention o Document Portfolio - lists learning artifacts III. The normal heart rate for a fetus is anywhere between 120 and 160 beats per minute.This is a rare condition, occurring in only 1-2% of pregnancies, and is normally a temporary, benign occurrence. Rev Port Cardiol. 2012;28:9503. Br J Obstet Gynaecol. (eds) 11th Mediterranean Conference on Medical and Biomedical Engineering and Computing 2007. In addition, any fetal kicking or motion produces a very loud noise that will saturate the automatic gain system on the monitors amplifier, resulting in complete loss of recording for several seconds while waiting for the amplifier to reopen. Flecainide is an effective first-line treatment for fetal SVT with a high successful rate of 88.2%, low side effect and relatively easy utilization [33]. to use this representational knowledge to guide current and future action. Fetal arrhythmias are a common phenomenon with rather complicated etiologies. Pathol Biol. This mechanical energy may be sensed by a microphone and amplified, producing an electrical signal that may then be reconverted to sound or used to produce a phonocardiogram, an oscillographic tracing of the heart sounds. The upper panel shows the heart rate from a fetal scalp electrode (FHR) and maternal leads (MHR) with a dead fetus. Prenatal Diagnosis of Fetal Heart Failure. 2016;5:e003673. Disturbances of cardiac rhythm or arrhythmias are common in people, often benign, and often intermittent. If the transmitted maternal pacemaker pulse is at a higher voltage than the fetal R wave, the scalp electrode may record the pacemaker signal (, In the absence of the fetal ECG signal, such as with a dead fetus, there will usually be no tracing. Ultrasound Obstet Gynecol. PubMed Central It also extracts 16 significant features from multiple domains, including (time, frequency, and time-frequency features. PubMed Amiodarone, propafenone, and combined therapies are reserved for refractory fetal tachycardias [30]. Prenatal features of Costello syndrome: ultrasonographic findings and atrial tachycardia. YSM: Substantial contribution to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved. fetal arrhythmia vs artifactdiscretionary housing payment hackney. The normal heart rate for a fetus is anywhere between 120 and 160 beats per minute.This is a rare condition, occurring in only 1-2% of pregnancies, and is normally a temporary, benign occurrence. Aggarwal S, Czaplicki S, Chintala K. Hemodynamic effect of fetal supraventricular tachycardia on the unaffected twin. 2004;24:1127. All those with complete AV block by maternal autoantibodies positivity survived, but 42.8% needed a pacemaker. Flecainide as first-line treatment for fetal supraventricular tachycardia. 2012 Jun 1;109(11):1614-8. doi: 10.1016/j.amjcard.2012.01.388. Multifocal atrial and ventricular premature contractions with an increased risk of dilated cardiomyopathy caused by a Nav1.5 gain-of-function mutation (G213D). 2016;13:12838. Br Heart J. All of the following are likely causes of prolonged decelerations except: A. J Cardiol Curr Res. The Novii Wireless Patch System is an is an intrapartum maternal/fetal monitor** that noninvasively measures and displays fetal heart rate (FHR), maternal heart rate (MHR), and uterine activity (UA). what is multiplicative comparison. 2019;69:3836. 11th Mediterranean Conference on Medical and Biomedical Engineering and Computing 2007, https://doi.org/10.1007/978-3-540-73044-6_205, Shipping restrictions may apply, check to see if you are impacted, Tax calculation will be finalised during checkout. However, they can be severe sometimes leading to cardiac compromise. FHR tracings from a fetal scalp electrode (FSE) are obtained by measuring the interval between consecutive fetal R waves. 2018;257:1607. If the interface is moving, the reflected signal undergoes a frequency change (Doppler shift). 2018;11:14863. Fetal arrhythmia is a term that refers to any abnormality in the heart rate of your baby. Please enable it to take advantage of the complete set of features! [38] reported that successful drug treatment with sotalol in 5/6 (83.3%) cases with no adverse effects for the mothers. Ultrasound Obstet Gynecol. Use spiral electrode & turn off logic. 1981;88:124638. There are other rare types of fetal arrhythmias, such as ventricular tachycardia, junctional tachycardia, and multiforcal atrial tachycardia [14]. The modes of administration, intraumbilical, intraamniotic, intraperitoneal, intramuscular and intracardiac, have been selected as routes of administration. Fouron J. Up-to-date . Development of the cardiac conduction system: why are some regions of the heart more arrhythmogenic than others? [45] applied fetal esophageal pacing with a bipolar pacing esophageal lead (FIAB Esokid 4S, Firenze, Italy) positioned behind the left atrium for the treatment of fetal AF. Transient bradycardia is somewhat common in the developing fetus and is usually benign. Ultrasound Obstet Gynecol. Provided by the Springer Nature SharedIt content-sharing initiative. Artifact is the interference seen on the monitor or strip which may look like a wandering or fuzzy baseline. Successful in utero transesophageal pacing for severe drug-resistant tachyarrhythmia. Hydrops fetalis resolved in 62.5% (5/8) fetuses, with a mean resolution time of 28.4days [42]. Master of Engineering. Watch this videoFor any support, please contact Mindray India on the below . Apply intervention and collect data o Process Portfolio - demonstrates steps on how IV. 2018;11:349. 2023 Springer Nature Switzerland AG. XZY: Substantial contribution to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved. Less common but more fatal are those that cause low cardiac output, foetal hydrops and death. Most errors we see in FHR interpretation are related to the quality of the data acquisition and presentation, and, for this reason, an understanding of this chapter is critical for the clinician using electronic fetal monitoring in the treatment of obstetric patients. Clipboard, Search History, and several other advanced features are temporarily unavailable. Both fetal magnetocardiogram and electrocardiogram provide information of cardiac time intervals, including the QRS and QT durations. Oral flecainide (100mg three times daily) is reserved for those cases unresponsive to sotalol and digoxin [34]. Italian Journal of Pediatrics Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. 2018;122:A20644. 2003;29:S85. 2015;25:44753. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. It does not necessarily represent mechanical activity. 2011;38:40612. Keywords: & Gynecol. The highest point of the waveform is detected and recorded as a heart beat, even though it may not appear at the same time in each waveform. Sinus bradycardias are often caused by fetal hypoxia or immaturity of the cardiac conduction system. The lower panel shows the fetal scalp lead and the maternal lead electrocardiogram (ECG) tracing indicating that the dead fetus is transmitting the maternal ECG to the fetal lead. HUM 100 Cultures and Artifacts Worksheet; Problem Set Week1 - Week One Assignment; 1-7 HW Key - Problems and answers . Fetal arrhythmias are a common phenomenon with rather complicated etiologies. 2017;6:e007164. Oudijk MA, Visser GH, Meijboom EJ. It connects to the Corometrics 259cx Series . An arrhythmia is an irregular rhythm of the heart in which abnormal electrical signals through the heart muscle may cause the heart to beat too fast (tachycardia), too slowly (bradycardia), or in an erratic pattern. Fetal cardiac arrhythmias: current evidence. 2016;5:414. J Am Heart Assoc. Fetal congenital arrhythmia is an irregular beating of the heart of a fetus, caused by a congenital disability or an inherited genetic condition. 2012;109:16148. Karmegeraj B, Namdeo S, Sudhakar A, Krishnan V, Kunjukutty R, Vaidyanathan B. Fetal bradyarrhythmia associated with congenital heart defects - nationwide survey in Japan. Donald Sch J Ultrasound Obstet Genycol. Although US clinicians find 1 cm/minute tracings are harder to read than the same tracings at 3 cm/minute, the slower rate of tracing is commonly used in Europe, South America, and certain centers in this country. Google Scholar. Most fetuses (75%) converted to sinus rhythm within 7days of treatment [37]. Both, artifacts and cardiac arrhythmias represent outliers of the FHR signals, so they affect both time domain and time frequency signal analysis. Theology - yea; . The fetal ECG signal is acquired through a bipolar electrode that penetrates the skin of the fetal scalp (first pole) and that has a second conductor residing in the secretions of the maternal vagina (second pole). Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur SA, Rammeloo L, et al. 2009;35:6239. The filtered signal is converted to an electrical waveform by the transducer, and it is this waveform that is used to generate and display the FHR. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The pregnant uterus is a closed, fluid-filled space. Fetal arrhythmias. Fetal Arrhythmia/Dysrhythmia. Fetal magnetocardiography (MCG) allows real-time detection and classification of arrhythmias [18] with better signal quality than electrocardiography due to more favorable transmission properties of the magnetic signals. In long VA tachycardia, an A wave of normal amplitude with normal AV time interval could be detected in front of the aortic ejection wave [16]. Arrhythmia. Tutschek B, Schmidt KG. Bethesda, MD 20894, Web Policies Aim: We aim to report a case of an enlarged fetal thymus causing arrhythmia. Moreover, fetal cardiac arrhythmias can have an effect on FHR signals. Fetal demise occurred in 5 (26.3%), and neonatal death in 10 (41.7%). 2008;4:17248. Fetal arrhythmia is rare. Gembruch U, Hansmann M, Redel DA, Bald R. Intrauterine therapy of fetal tachyarrhythmias: intraperitoneal administration of antiarrhythmic drugs to the fetus in fetal tachyarrhythmias with severe hydrops fetalis. J Perinatol. It is more effective than digoxin, especially for hydropic fetal tachycardia, with no adverse fetal outcomes found [14]. Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, Peoples Republic of China, You can also search for this author in Although most fetal arrhythmias are benign, some cause fetal hydrops and can lead to fetal death. Arrhythmia means no regular rhythm and dysrhythmia means abnormal rhythm. [13] reported that they used a two-dimensional scan head with M-mode recordings for the diagnosis of fetal arrhythmias. In fetuses with premature contractions, fetal echocardiogram is useful for cardiac structural and functional assessments, and for disclosing the mechanisms of fetal isolated PACs and multiple ectopic beats [21]. Article Ultrasonic signals can penetrate human tissue. D. Maternal fever. official website and that any information you provide is encrypted CAS Digoxin is more suitable for rhythm conversion of fetal AF and SVT in fetuses free of hydrops fetalis, while sotalol shows better effects for those with hydrops fetalis. Arrhythmia most often refers to an irregular heartbeat, while dysrhythmia represents all types of abnormal heartbeats: the heartbeat can be too fast (tachycardia) or too slow (bradycardia). Benign fetal arrhythmias, such as premature contractions and sinus tachycardia, do not need any perinatal treatments. This is known as fetal arrhythmia. Capuruo et al. It is indicated for fetal long QT syndrome type 2 and complete AV block [45]. The mechanisms of fetal bradycardia were complete AV block (14/29, 48.3%), second-degree AV block (8/19, 42.1%). [23] reported that PACs required antiarrhythmic treatments with digoxin, verapamil, or both in 14% of the cases. 50, no. The electronic circuitry of the fetal monitor senses this frequency change and converts it to an electronic signal. Sotalol is usually well-tolerated and has little or no negative inotropic effect on the fetal heart. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). These arrhythmias do not represent an expression of the physiological behavior of the ANS. Application of this knowledge may prevent fetal injury and death. Doppler waveforms detected from the inferior vena cava and the descending aorta helps in obtaining information of atrial and ventricular systoles simultaneously. SVT mechanism was classified by mechanical VA time intervals as short VA or long VA. One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. Carpenter RJ Jr, Strasburger JF, Garson A Jr, Smith RT, Deter RL, Engelhardt HT Jr. Fetal ventricular pacing for hydrops secondary to complete atrioventricular block. The main drawback to phonocardiographically derived FHR systems is that they are extremely sensitive to ambient noise such as maternal bowel sounds, voices in the room, certain air-conditioning systems, and, especially, noise produced by any motion of the microphone or of the bed clothing against the microphone. Ethics, Husbandry, and Fetal Treatment Following institutional and external review and approval of the protocol (IACUC-UTHSCSA #20110096AP; USDA protocol #74-R-003; OLAW-NIH #D16-00048), we utilized the 125-day gestational (postmenstrual) age, 14 days ventilated baboon model of extreme prematurity described by Seidner et al. Besides, sustained fetal arrhythmias predispose to the occurrence of hydrops fetalis, cardiac dysfunction, or even fetal demise [10]. Complete AV block occurred in 2.6% of fetuses with irregular cardiac rhythyms [47]. The phonocardiographic signal is clearer than the Doppler signal, resulting in less artifactual jitter. For this reason, phonocardiography historically was widely used for antepartum FHR monitoring. The "a" prefix in arrhythmia means a lack or an absence of something. Rev Med Suisse. Can digoxin and sotalol therapy for fetal supraventricular tachycardia and hydrops be successful? Long QT syndrome can cause 2:1 AV block or sinus bradycardia. A transducer innovation employed by second-generation monitors is pulsed Doppler. If the FHR exceeds 240 BPM, not even a direct fetal ECG system will count every beat and may halve or not print such rates. Accessibility Clinically, uterine contractions can be monitored by two techniques: external tocodynamometry or intrauterine pressure measurement. HHS Vulnerability Disclosure, Help With combined flecainide and digoxin therapy, conversion to sinus rhythm occurred within 5days (range, 014days). The overall mortality was 8%, only 4% of which was arrhythmia-related. 2009;29:68290. Shah et al. Privacy Request PDF | Cardiac arrhythmias and artifacts in fetal heart rate signals: detection and correction | Cardiotocography is the most commonly used noninvasive diagnostic technique that provides . This safe, noninvasive test shows the structure of the heart and helps determine the type of arrhythmia. Fetal tachyarrhythmias are usually SVT (63.4%), AF (28.0%) and VT (8.5%). (2007). Ekiz A, Kaya B, Bornaun H, Acar DK, Avci ME, Bestel A, et al. Fetal arrhythmias are common, and they may resolve spontaneously in majority of the cases. Intrauterine pressure has historically been determined with the use of an open-ended, fluid-filled catheter placed through the cervix and externally attached to a strain gauge transducer. Sotalol and flecainide have good placental transfer ability, and they should be used as first-line treatment for hydropic fetal tachyrrhythmias. In fetal cases of atrioventricular blocks, an etiological treatment for the maternal antibody exposure by steroids could be an alternative remedy. Yaksh A, van der Does LJME, Lanters EAH, de Groot NMS. Despite various electronic logic and filtering processes, this often results in an apparent increase in short-term variability due to a false reproduction of the actual interval from one heart beat or R wave (contraction) to the next (, Although not new in concept, the application of autocorrelation to FHR technology has been made possible by the introduction of high-speed microprocessor integrated circuitry. 2022 Jul 15;12(7):1722. doi: 10.3390/diagnostics12071722. In this study, a machine learning framework for fetal arrhythmia detection. 1):167269. Moreover, heart function and congenital heart defects exaggerate the severity of congestive heart failure [15]. For fetuses with hydrops, the placental transfer of the digoxin is limited. J Arrhythm. 2002;17:757. Crowley DC, Dick M, Rayburn WF, Rosenthal A. Two-dimensional and M-mode echocardiographic evaluation of fetal arrhythmia. Detection of fetal motion with Doppler signal is the same with both the older and newer monitors. Google Scholar. Currently, ultrasound is the only widely used method of studying fetal anatomy and physiology, but it has significant limitations for assessment of cardiac rhythm. Respondek et al. The anatomic M-mode provides simultaneous two-dimensional real-time images and therfore can obtain good quality tracings of atria and ventricles than by standard M-mode views. The choice of vertical and horizontal scaling directly affects the appearance of the FHR and uterine contraction tracings. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. However, any . 2013 Sep;42(3):285-93. doi: 10.1002/uog.12390. PubMed The pulsed Doppler transducer alternates the emission of ultrasound waves with the reception of the reflected waves, resulting in a decrease in both the amount and time of exposure of the fetus to ultrasound energy. . For long VA SVT, the conversion rate to sinus rhythm did not differ significantly between the two drugs (67% vs. 50%, P=0.13). Note the two rates are identical in detail. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article.