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January 1, 2003Japanese Heart JournalOpen Access

External Cardioversion in Patients With Persistent Atrial Fibrillation A Reappraisal of the Effects of Electrode Pad Position and Transthoracic Impedance on Cardioversion Success.

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Key result

Anteroposterior electrode pad positioning significantly lowered transthoracic impedance but did not improve cumulative cardioversion success rates compared to conventional anterolateral positioning (84.6% vs 83.9%).

Why the study?

Does anteroposterior electrode pad position improve cardioversion success compared to anterolateral position in patients with persistent atrial fibrillation?

Population

70 patients with persistent atrial fibrillation undergoing elective cardioversion

Comparison

Electrode pad position over the right lower… vs Electrode pad position situated over the…

Design

RCT, randomly assigned

Authors

CCChien‐Jen ChenGGG. Bih-Fang Guo

Discussion

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Overview

Anterolateral positioning remains acceptable for cardioversion in persistent AF; confirms transthoracic impedance as the dominant predictor of success over pad placement.

Study Design

Type

RCT (n=70)

Blinding

Open-label

Randomization

Randomly assigned

Multicenter

No

Structured PICO

Does anteroposterior electrode pad position improve cardioversion success compared to anterolateral position in patients with persistent atrial fibrillation?

P
Population
70 patients with persistent atrial fibrillation (duration ≥ 1 month) undergoing elective cardioversion were randomized to different electrode pad positions.
I
Intervention
Electrode pad position over the right lower sternal border-left infrascapular area close to the spine (AP group, n=39)
C
Comparator
Electrode pad position situated over the ventricular apex-right infraclavicular area (AL group, n=31)
O
Outcome
Cumulative cardioversion success rates at escalating energy levels (100 J, 150 J, 200 J, 300 J, and 360 J)

Main Result

Absolute Event Rate: 84.6% vs 83.9%

Transthoracic impedance, rather than electrode pad position, is the primary determinant of external cardioversion success and correlates with energy requirement in persistent atrial fibrillation.

Limitations

  • Small number of participants limiting statistical power to detect differences between groups
  • Heterogeneous patient population in terms of associated diseases, AF duration, and use of antiarrhythmic agents

Cite This Study

Chen et al. (2003) conducted an RCT in Persistent Atrial Fibrillation (n=70). Anteroposterior (AP) electrode pad position vs. Anterolateral (AL) electrode pad position was evaluated on Cumulative cardioversion success rate at maximum energy (360 J). Anteroposterior electrode pad positioning significantly lowered transthoracic impedance but did not improve cumulative cardioversion success rates compared to conventional anterolateral positioning (84.6% vs 83.9%).

synapsesocial.com/papers/6a24072598edd3e1959ef044https://doi.org/10.1536/jhj.44.921
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Randomised comparison of electrode positions for cardioversion of atrial fibrillation1999 · 87 citations
  2. 2External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements1999 · 174 citations
  3. 3Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation2000 · 153 citations
  4. 4ABC of Atrial Fibrillation: CARDIOVERSION OF ATRIAL FIBRILLATION1996 · 14 citations
  5. 5FACTORS INFLUENCING PERSISTENCE OF SINUS RHYTHM AFTER DC SHOCK TREATMENT OF ATRIAL FIBRILLATION1971 · 79 citations