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
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