Manual chest pressure during electrical cardioversion for atrial fibrillation did not significantly improve success (OR 1.47; p=0.508) or reduce energy/shocks in 696 patients.
Does manual chest pressure improve cardioversion success in patients undergoing electric cardioversion for atrial fibrillation?
The application of manual chest pressure during electrical cardioversion for atrial fibrillation does not significantly improve cardioversion success or reduce energy requirements.
Absolute Event Rate: 0% vs 0%
Abstract Background Current guidelines for the management of atrial fibrillation suggest that the use of manual chest pressure during electric cardioversion may improve its efficacy. While manual pressure during shock delivery has shown to decrease transthoracic impedance, the clinical benefits of this strategy are uncertain and based on limited data. We aimed to evaluate the effectiveness of the use of manual pressure in comparison with a standard approach in patients undergoing electric cardioversion for atrial fibrillation. Methods This systematic review and meta-analysis was performed according to the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Data were gathered from PubMed, Embase and Cochrane databases until January 2025. We included randomized controlled trials (RCT) comparing manual pressure with the standard approach in electrical cardioversion of atrial fibrillation. Outcomes included cardioversion success, mean energy delivery and number of shocks. A random-effects model was used for outcomes with high heterogeneity. Results We included 4 RCTs comprising a total of 696 patients (350 in the manual pressure group, 346 in the control group). Mean BMI of intervention and control groups was respectively 33 and 32 kg/m². The pooled analysis demonstrated no statistically significant difference in cardioversion success (OR 1.47; 95%CI 0.47 - 4.56; p=0.508), mean energy delivery (OR -0.094; 95%CI -0.555 - 0.366; p=0.689) and mean number of shocks (OR -0,191; 95%CI -0,539 . 0.158; p=0.283) of a manual pressure strategy in comparison with a standard approach. Conclusion These findings suggest that the application of manual chest pressure during electric cardioversion does not result in improved cardioversion success or reduced energy requirements in individuals with atrial fibrillation.
Muniz et al. (Sat,) reported a other. Manual chest pressure during electrical cardioversion for atrial fibrillation did not significantly improve success (OR 1.47; p=0.508) or reduce energy/shocks in 696 patients.