Clinical factors related to successful or unsuccessful cardioversion in the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE‐AF) randomized trial

Lip, Gregory Y.H.; Merino, José Luís; Banach, Maciej; Al-Saady, N.; Jin, James; Melino, Michael; Winters, Shannon M; Kozieł, Monika; Goette, Andreas

doi:10.1002/joa3.12341

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Meanwhile, patient-related factors for successful EDCCV include primarily high BMI and male gender. 26 In our study, there was no difference between genders with regards to success rate, but higher BMI was associated with the need for more than one cardioversion attempt. Obesity impedes the delivery of adequate direct current energy to the atrial tissue and increases TTI, which can be overcome by applying additional energy.…”

Section: Discussioncontrasting

confidence: 45%

A stepwise external cardioversion protocol for atrial fibrillation to maximize acute success rate

et al. 2023

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Aims Cardioversion is a very commonly performed procedure for persistent atrial fibrillation (AF). However, there is no well-defined protocol to address failed external electrical direct current cardioversion. The aim of the study is to test the efficacy of a pre-defined stepwise cardioversion protocol for patients with persistent AF of ≤12 months. Success was the achievement of sinus rhythm. Methods and results The study population included patients with persistent AF of ≤12 months duration requiring rhythm management. Patients were offered cardioversion using a pre-defined stepwise protocol using different electrode placement locations, applying compression at end of expiration, and higher energy delivered simultaneously through two defibrillators. : A total of 414 patients were included in the study, of which 362 (87.4%) required a single successful cardioversion. The remaining 52 (12.5%) patients required additional cardioversion attempts using the stepwise cardioversion protocol with an overall success rate of 99.3%. Two simultaneous defibrillators were required in 14 patients (3.4%). Patients with multiple cardioversions (13.5%) experienced more local skin irritation and pain compared with patients with single cardioversion (13.5% vs. 3.5%, P = 0.004). The predictor for the need for multiple cardioversion attempts is high body mass index, while high transthoracic impedance is associated with failed cardioversion. No major complications were observed during the study. Conclusion The stepwise cardioversion protocol has a high success rate of >99% and can be safely performed in outpatient or inpatient settings.

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Section: Discussioncontrasting

confidence: 45%

A stepwise external cardioversion protocol for atrial fibrillation to maximize acute success rate

et al. 2023

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“…In the multicenter prospective trial ENSURE-AF by Lip et al [9] clinical factors affecting CVE efficacy as well as adverse events of anticoagulation therapy were analyzed. In ENSURE-AF 2199 patients were randomized to endoxaban or enoxaparin-warfarin group.…”

Section: Discussionmentioning

confidence: 99%

Wpływ otyłości na skuteczność kardiowersji elektrycznej u pacjentów z przetrwałym migotaniem przedsionków

et al. 2021

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Introduction: Obesity's influence on the effectiveness of electrical cardioversion (CVE) still requires more studies. The study aimed to evaluate the impact of obesity on the efficacy of CVE in atrial fibrillation (AF).Material and methods: Eighty-nine patients [female/male (F/M): 33/56; mean age: 64.66 ± 9.7 years) with persistent symptomatic AF qualified for CVE were prospectively enrolled in the study. CVE efficacy was analyzed immediately after the procedure and in a one-month follow-up. Patients with immediately efficient CVE were divided into obese group [OG; body mass index) BMI ≥ 30 kg/m 2 , 49 patients, F/M: 21/28, mean age: 64 ± 10 y.) and non-obese group (NOG; < 30 kg/m 2 , 33 patients, F/M: 9/24, mean age: 66 ± 10 y.).Results: Immediate CVE efficacy was 92%. Sinus rhythm restoration was not BMIdependent, but BMI had an impact on the amount of energy needed for sinus rhythm restoration (150 J in NOG vs. 200 J in OG, p < 0.05). One-month CVE efficacy was 47%: 38.8% in OG and 60.6% in NOG (p < 0.05). Patients in OG had greater left atrium (LA) and left ventricle (LV) diameters (p < 0.05) and lower LV ejection fraction (EF) (p < 0.05) as compared to NOG subjects. Logistic regression analysis revealed LV EF [odds ratio (OR):1.107, 95% CI: 1.015-1.207, p < 0.05] as a factor influencing one-month CVE efficacy. Conclusions:Immediate high efficacy of CVE in persistent AF seems to be independent of coexisting obesity, however, obesity has an impact on the amount of energy needed for sinus rhythm restoration. One-month efficacy of CVE is low and modified by coexisting obesity.

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“…Hence, as clinicians, we should direct our focus toward specific at-risk groups such as adolescents who, paradoxically, are at increased cardiac risk due to the epidemics of obesity, inadequate nutrition, smoking and alcohol abuse [78,79]. Of note, obesity [and male gender] were independent predictors of failed cardioversion [80], whereas weight-loss was related to the maintenance of sinus rhythm [81]. Likewise, the RACE 3 was a RCT of 245 patients with early persistent AF and mild-to-moderate heart failure randomized to the targeted therapy of underlying conditions or conventional therapy [82].…”

Section: Expert Opinion On the Future Of Af Managementmentioning

confidence: 99%

Clinical outcomes following rhythm control for atrial fibrillation: is early better?

Kotalczyk

Ding

Gupta

et al. 2021

Expert Review of Cardiovascular Therapy

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Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective 'real-world' registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF. Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy. Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.

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Clinical factors related to successful or unsuccessful cardioversion in the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE‐AF) randomized trial

Cited by 6 publications

References 18 publications

A stepwise external cardioversion protocol for atrial fibrillation to maximize acute success rate

A stepwise external cardioversion protocol for atrial fibrillation to maximize acute success rate

Wpływ otyłości na skuteczność kardiowersji elektrycznej u pacjentów z przetrwałym migotaniem przedsionków

Clinical outcomes following rhythm control for atrial fibrillation: is early better?

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