Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial

Abstract

First-shock success was significantly higher, particularly in patients with a BMI >25 kg/m(2), when a non-escalating initial 200 J energy was selected. The overall success, duration of procedure and amount of sedation administered, however, did not differ significantly between the two protocols.

Part 8: Adult Advanced Cardiovascular Life Support

“…[372][373][374][375][376] If the initial shock fails, providers should increase the dose in a stepwise fashion.…”

Treatment of new-onset atrial fibrillation in noncardiac intensive care unit patients: A systematic review of randomized controlled trials*

“…This is especially true for the patient with newonset atrial fibrillation and deteriorating hemodynamics where prompt restoration of sinus rhythm is essential and avoiding pharmacologic exacerbation of hypotension is pivotal. In noncritically ill patients direct current cardioversion has been described as a highly effective therapy with rates of successful restoration of normal sinus rhythm as high as 70 to 95% (27)(28)(29). However, only one prospective observational study of monophasic direct current cardioversion in 37 surgical ICU patients reports a successful initial conversion rate of 35% and only 13.5% at 48 hrs (30).…”

Part 6: Defibrillation

“…Twenty-two studies have compared specific cardioversion strategies (eg, monophasic versus biphasic defibrillators and different energy levels) administered by cardiologists in the hospital setting to patients with atrial fibrillation (both acute and chronic) (LOE 1 14,17,26,27,31,[102][103][104][105][106][107][108][109][110][111][112][113][114][115] ; LOE 2 116,117 ). Most of these studies documented that biphasic shocks were more effective than monophasic shocks for cardioversion.…”