DC cardioversion of persistent atrial fibrillation: a comparison of two protocols

International Journal of Cardiology
Lana BoodhooNeil Sulke

Abstract

Current guidelines for transthoracic direct-current cardioversion (DCCV) of atrial fibrillation (AF) recommend a step-up energy protocol. The aim of this study was to compare such a protocol with a protocol involving a high initial energy shock, anteroposterior paddle position and reversal of shock polarity, on cardioversion efficacy, total energy delivery, use of sedation and patient tolerability. 261 patients (mean age 71+/-10 years, 62% male) referred for elective DCCV of persistent AF were enrolled. Patients were randomised to either protocol A: (1) 200 J anteroapical, (2) 360 J anteroapical, (3) 360 J anteroposterior; or protocol B: (1) 360 J anteroapical, (2) 360 J anteroposterior, and (3) 360 J posteroanterior. All procedures were performed under sedation with intravenous diazepam. Protocol B improved shock success rates (protocol A first shock success rate=42%, protocol B=68%, p<0.001; protocol A second shock success rate=72%, protocol B 86%, p=0.006; protocol A third shock success rate=83%, protocol B=92%, p=0.03) and required fewer shocks to achieve sinus rhythm (1.3+/-0.6) compared with protocol A (1.6+/-0.7, p<0.001). There were no differences in cumulative energy used (protocol A 473+/-286 J, protocol B 436+/-273 J...Continue Reading

References

Sep 3, 1998·The New England Journal of Medicine·M HaïssaguerreJ Clémenty
Nov 24, 1999·The American Journal of Cardiology·I C Van GelderH J Crijns
Aug 3, 2000·The American Journal of Cardiology·J A JoglarR L Page
Oct 17, 2001·Heart·R RaipancholiaM Lynch
Nov 3, 2001·Journal of the American College of Cardiology·M M GallagherA J Camm
Jul 10, 2003·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·C BoosR S More
Feb 3, 2004·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·A R J MitchellN Sulke

❮ Previous
Next ❯

Citations

Apr 9, 2011·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·C H N TrompA C Bolte
Nov 24, 2011·Emergency Medicine Clinics of North America·Peter P MonteleoneSeth O Althoff
Oct 20, 2010·Resuscitation·Jerry P NolanUNKNOWN ERC Guidelines Writing Group
Sep 17, 2011·Revista brasileira de anestesiologia·Luiz Fernando dos Reis FalcãoJosé Luiz Gomes do Amaral
Sep 11, 2019·European Heart Journal·Anders S SchmidtBo Løfgren

❮ Previous
Next ❯

Related Concepts

Related Feeds

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Anti-Arrhythmic Drug Therapies

Anti-arrhythmic drugs are used to prevent abnormal heart rhythms. These medications are used in conditions including, ventricular tachycardia, ventricular fibrillation and atrial fibrillation. Discover the latest research on anti-arrhythmic drug therapies here.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Antiarrhythmic Agents: Mechanisms of Action

Understanding the mechanism of action of antiarrhythmic agents is essential in developing new medications as treatment of cardiac arrhythmias is currently limited by the reduced availability of safe and effective drugs. Discover the latest research on Antiarrhythmic Agents: Mechanism of Action here.