Active compression versus standard anterior-posterior defibrillation for external cardioversion of atrial fibrillation : A prospective randomized study
Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Electrical cardioversion is the first-line rhythm control therapy for symptomatic persistent atrial fibrillation (AF). Contemporary use of biphasic shock waveforms and anterior-posterior positioning of defibrillation electrodes have improved cardioversion efficacy; however, it remains unsuccessful in >10% of patients.
OBJECTIVE: The purpose of this study was to assess the efficacy of applying active compression on defibrillation electrodes during AF cardioversion.
METHODS: We performed a bicenter randomized study including patients referred for persistent AF cardioversion. Elective external cardioversion was performed by a standardized step-up protocol with increasing biphasic shock energy (50-100-150-200 J). Patients were randomly assigned to standard anterior-posterior defibrillation or to defibrillation with active compression applied over the anterior electrode. If sinus rhythm was not achieved at 200 J, a single crossover shock (200 J) was applied. Defibrillation threshold, total delivered energy, number of shocks, and success rate were compared between groups.
RESULTS: We included 100 patients, 50 in each group. In the active compression group, defibrillation threshold was lower (103.1 ± 49.9 J vs 130.4 ± 47.7 J; P = .008), as well as total delivered energy (203 ± 173.3 J vs 309 ± 213.5 J; P = .0076) and number of shocks (2.2 ± 1.1 vs 2.9 ± 1.2; P = .0033), and cardioversion was more often successful (48 of 50 patients [96%] vs 42 of 50 patients [84%]; P = .0455) than that in the standard anterior-posterior group. Crossover from the compression group to the standard group was not successful (0 of 2 patients), whereas crossover from the standard group to the compression group was successful in 50% of patients (4 of 8).
CONCLUSION: Active compression applied to the anterior defibrillation electrode is more effective for persistent AF cardioversion than standard anterior-posterior cardioversion, with lower defibrillation threshold and higher success rate.
Medienart: |
E-Artikel |
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Erscheinungsjahr: |
2021 |
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Erschienen: |
2021 |
Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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Enthalten in: |
Heart rhythm - 18(2021), 3 vom: 25. März, Seite 360-365 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Squara, Fabien [VerfasserIn] |
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Links: |
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Themen: |
Atrial fibrillation |
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Anmerkungen: |
Date Completed 20.12.2021 Date Revised 20.12.2021 published: Print-Electronic Citation Status MEDLINE |
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doi: |
10.1016/j.hrthm.2020.11.005 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM317488376 |
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245 | 1 | 0 | |a Active compression versus standard anterior-posterior defibrillation for external cardioversion of atrial fibrillation |b A prospective randomized study |
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500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. | ||
520 | |a BACKGROUND: Electrical cardioversion is the first-line rhythm control therapy for symptomatic persistent atrial fibrillation (AF). Contemporary use of biphasic shock waveforms and anterior-posterior positioning of defibrillation electrodes have improved cardioversion efficacy; however, it remains unsuccessful in >10% of patients | ||
520 | |a OBJECTIVE: The purpose of this study was to assess the efficacy of applying active compression on defibrillation electrodes during AF cardioversion | ||
520 | |a METHODS: We performed a bicenter randomized study including patients referred for persistent AF cardioversion. Elective external cardioversion was performed by a standardized step-up protocol with increasing biphasic shock energy (50-100-150-200 J). Patients were randomly assigned to standard anterior-posterior defibrillation or to defibrillation with active compression applied over the anterior electrode. If sinus rhythm was not achieved at 200 J, a single crossover shock (200 J) was applied. Defibrillation threshold, total delivered energy, number of shocks, and success rate were compared between groups | ||
520 | |a RESULTS: We included 100 patients, 50 in each group. In the active compression group, defibrillation threshold was lower (103.1 ± 49.9 J vs 130.4 ± 47.7 J; P = .008), as well as total delivered energy (203 ± 173.3 J vs 309 ± 213.5 J; P = .0076) and number of shocks (2.2 ± 1.1 vs 2.9 ± 1.2; P = .0033), and cardioversion was more often successful (48 of 50 patients [96%] vs 42 of 50 patients [84%]; P = .0455) than that in the standard anterior-posterior group. Crossover from the compression group to the standard group was not successful (0 of 2 patients), whereas crossover from the standard group to the compression group was successful in 50% of patients (4 of 8) | ||
520 | |a CONCLUSION: Active compression applied to the anterior defibrillation electrode is more effective for persistent AF cardioversion than standard anterior-posterior cardioversion, with lower defibrillation threshold and higher success rate | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Multicenter Study | |
650 | 4 | |a Randomized Controlled Trial | |
650 | 4 | |a Atrial fibrillation | |
650 | 4 | |a Cardioversion | |
650 | 4 | |a Compression | |
650 | 4 | |a Defibrillation | |
650 | 4 | |a Pressure | |
700 | 1 | |a Elbaum, Clara |e verfasserin |4 aut | |
700 | 1 | |a Garret, Gauthier |e verfasserin |4 aut | |
700 | 1 | |a Liprandi, Laurent |e verfasserin |4 aut | |
700 | 1 | |a Scarlatti, Didier |e verfasserin |4 aut | |
700 | 1 | |a Bun, Sok-Sithikun |e verfasserin |4 aut | |
700 | 1 | |a Mossaz, Baptiste |e verfasserin |4 aut | |
700 | 1 | |a Rocher, Marie |e verfasserin |4 aut | |
700 | 1 | |a Bateau, Jules |e verfasserin |4 aut | |
700 | 1 | |a Moceri, Pamela |e verfasserin |4 aut | |
700 | 1 | |a Ferrari, Emile |e verfasserin |4 aut | |
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