Safety of Electrical Cardioversion in Patients Without Digitalis Toxicity

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Abstract
To ascertain whether electrical cardioversion increases ventricular ectopy in patients receiving nontoxic doses of digitalis, continuous ECG were recorded in 21 patients for at least 1 h before and immediately after DC countershock. There were no consistent differences in the frequency or severity of ventricular ectopy before and after cardioversion despite a wide range of serum digoxin levels (0.1-3.0 ng/ml; mean, 1.6). No patient had ventricular tachycardia after cardioversion, and all 3 patients with serum digoxin levels > 2.0 ng/ml had the same or fewer ventricular ectopic beats per h and the same or lower ectopy grades after cardioversion when pre- and postshock recordings were compared. Patients receiving digoxin without clinical evidence of digitalis toxicity were at low risk for serious postcardioversion ventricular arrhythmias, even when serum digoxin levels were modestly elevated. The extent to which this low risk was due to concomitant antiarrhythmic therapy was unknown.