Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Figueiredo, Elisabeth Níglio de; Veloso, Henrique Horta; Paola, Ângelo Amato Vincenzo de

doi:10.1590/s0066-782x2002001100004

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…However, no consensus or recommendations about the initial energy level for DCCV exist, despite DCCV's common and practical use. Usually, the initial energy level for the shock is determined based on the type of arrhythmia and the operator's level of experience [6]. Unfortunately, this uncertainty has led to excessive myocardial damage and complications, such as post-cardioversion arrhythmia or coronary spasms [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Personal Thoracic Impedance on Electrical Cardioversion in Patients with Atrial Arrhythmias

et al. 2021

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Background and Objectives—Direct current cardioversion (DCCV) is a safe and useful treatment for atrial tachyarrhythmias. In the past, the energy delivered in DCCV was decided upon empirically, based only on the type of tachyarrhythmia. This conventional method does not consider individual factors and may lead to unnecessary electrical damage. Materials and Methods—We performed DCCV in patients with atrial tachyarrhythmias. The impedance and electrical current at the moment of shock were measured. The human thoracic impedance between both defibrillator patches and the electric current that was used were measured. Results—A total of 683 DCCVs were performed on 466 atrial tachyarrhythmia patients. The average impedance was 64 ± 11 Ω and the average successful current was 23 ± 6 mA. The magnitude of the electrical current that was successful depended upon the human impedance (linear regression, B = −0.266, p < 0.001) and the left atrial diameter (B = 0.092, p < 0.001). Impedance was directly proportional to body mass index (BMI) (B = 1.598, p < 0.001) and was higher in females than in males (77 ± 15 Ω vs. 63 ± 11 Ω, p < 0.001). Notably, the high-impedance (>70 Ω) group had a higher BMI (27 ± 4 kg/m2 vs. 25 ± 3 kg/m2, p < 0.001) and a higher proportion of females (37% vs. 9%, p < 0.001) than the low-impedance group (<70 Ω). However, thoracic impedance was not an independent predictor for successful DCCV. Conclusions—Human thoracic impedance was one of the factors that impacted the level of electrical current required for successful DCCV in patients with atrial arrhythmias. In the future, it will be helpful to consider individual predictors, such as BMI and gender, to minimize electrical damage during DCCV.

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Section: Introductionmentioning

confidence: 99%

The Impact of Personal Thoracic Impedance on Electrical Cardioversion in Patients with Atrial Arrhythmias

et al. 2021

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“… 23 , 24 , 25 , 26 The use of MPA on all our patients explains why our 100 J success rate was higher than the 40% to 49% previously reported studies. 4 , 8 , 27 …”

Section: Discussionmentioning

confidence: 99%

Impact of Defibrillator Electrode Placement on Outcome of Electrical Cardioversion of Atrial Fibrillation: A Pilot Observational Study

Madanat,

France,

Shoukri

et al. 2024

JAHA

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Background Anterior–posterior electrode placement is preferred in electrical cardioversion of atrial fibrillation. However, the optimal anterior–posterior electrode position in relation to the heart is not studied. Methods and Results We performed a prospective observational study on patients presenting for cardioversion of atrial fibrillation. Electrodes were placed in the anterior–posterior position and shock was delivered in a step‐up approach (100 J→200 J→360 J). Fluoroscopic images were obtained, and distances were measured from points A, midanterior electrode; and B, midposterior electrode, to midpoint of the cardiac silhouette. Patients requiring one 100 J shock for cardioversion success (group I) were compared with those requiring >1 shock/100 J (group II). Logistic regression was used to determine the impact of electrode distance on low energy (100 J) cardioversion success. Computed tomography scans from this cohort were analyzed for anatomic landmark correlation to the cardiac silhouette. Of the 87 patients included, 54 (62%) comprised group I and 33 (38%) group II. Group I had significantly lower distances from the mid–cardiac silhouette to points A (5.0±2.4 versus 7.4±3.3 cm; P <0.001) and B (7.3±3.0 versus 10.0±3.8 cm; P =0.002) compared with group II. On multivariate analysis, higher distances from the mid–cardiac silhouette to point A (odds ratio, 1.33 [95% CI, 1.07–1.70]; P =0.01) and B (odds rsatio, 1.24 [95% CI, 1.05–1.50]; P =0.01) were independent predictors of low energy (100 J) cardioversion failure. Based on review of computed tomography scans, we suggest that the xiphoid process may be an easy landmark to guide proximity to the myocardium. Conclusions In anterior–posterior electrode placement, closer proximity to the cardiac silhouette predicts successful 100 J cardioversion irrespective of clinical factors.

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“…It is a procedure used in the treatment of atrial fibrillation and flutter, alternatively or in addition to pharmacological therapy, with high conversion rate. [2345]…”

Section: Direct Current Cardioversionmentioning

confidence: 99%

Propofol for sedation for direct current cardioversion

2019

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Direct current cardioversion is a low-risk and standard procedure to restore normal sinus rhythm in patients with tachyarrhythmias. It requires sedation to facilitate the procedure, as it is painful and distressful. The preferred anesthetic drug must be short acting, producing conscious sedation, to enable rapid recovery after the procedure. In this sense, this narrative review focuses on the critical analysis of recent randomized studies and presents about the safety and effectiveness of propofol, comparing it with other established sedatives, mainly etomidate and midazolam. The research was performed on MEDLINE database with Propofol and Cardioversion keywords. In most cases, propofol comes to be the best option, with a quick recovery time and low rates of side effects. Different studies have demonstrated no inferiority when comparing to other drugs and, when these adverse events happened, they were easily and quickly handled. Exceptions in this scenario are those patients, particularly the elderly, with baseline important structural heart disease, in which etomidate with fentanyl has been pointed to lead to better hemodynamic stability.

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Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Abstract: Objective -To investigate the initial energy level required for electrical cardioversion of atrial fibrillation (AF). Methods -

Cited by 4 publications

References 19 publications

The Impact of Personal Thoracic Impedance on Electrical Cardioversion in Patients with Atrial Arrhythmias

The Impact of Personal Thoracic Impedance on Electrical Cardioversion in Patients with Atrial Arrhythmias

Impact of Defibrillator Electrode Placement on Outcome of Electrical Cardioversion of Atrial Fibrillation: A Pilot Observational Study

Propofol for sedation for direct current cardioversion

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