Initial energy for elective external cardioversion of persistent atrial fibrillation

Joglar, José A.; Hamdan, Mohamed H.; Ramaswamy, Karthik; Zagrodzky, Jason; Sheehan, Clifford J; Nelson, Lauren L.; Andrews, Thomas C.; Page, Richard L.

doi:10.1016/s0002-9149(00)00932-2

Cited by 83 publications

(46 citation statements)

References 9 publications

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“…Joglar et al 21 also noticed that the total number of shocks administered were was higher when initial energy levels were lower (2.8±1.2 with 100J; 2.2±1.4 with 200J, and 1.1±0.5 with 360J). The lower number of shocks administered in cardioversion is interesting especially because of a shorter sedation period, reducing risks like nausea, vomiting, and respiratory depression.…”

Section: Discussionmentioning

confidence: 94%

“…Sermasi et al 19 observed that cumulative energy in the 100J group was higher than that in the 200J group (303 versus 440J). Joglar et al 21 observed cumulative energy levels of 615±385J in the 100J group, 620±694J in 200J group, and 414±176J in 360J group, with significant differences between 100 and 360J groups (p=0.04), and a tendency toward in differences between the 100 and 200J groups (p=0.07), and no differences between the 100 and 200J groups. Unlike high-energy shocks used during cardiopulmonary resuscitation, recent studies [21][22][23][24] report that myocardium damage during electrical cardioversion of atrial fibrillation is minimal or absent.…”

Section: Discussionmentioning

confidence: 96%

“…Ricard et al 20 , in a nonrandomized prospective study in patients with atrial fibrillation lasting more than 24 hours, reported success rates of 22%, 48%, 75%, and 96% with 40 to 50J, 80 to 100J, 160 to 200J, and 360J, respectively. Joglar et al 21 , in the only randomized study for the assessment of initial energy of elective cardioversion of atrial fibrillation, also had higher efficacy of shocks using higher initial energy levels: cardioversion rates were 14% with 100J, 39% with 200J, and 90% with 360J.…”

Section: Discussionmentioning

confidence: 98%

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Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Figueiredo¹,

Veloso²,

Paola³

2002

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Figueiredo¹,

Veloso²,

Paola³

2002

Arq. Bras. Cardiol.

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“…Eine Studie zur elektrischen AF Kardi oversion deutete darauf hin, dass 360 J MDS Schocks wirksamer waren als 100 J oder 200 J MDS Schocks [185]. Ob wohl ein initialer 360 J Schock den Ge samtenergiebedarf für die Kardioversi on reduziert [185], könnte dieser einen größeren Myokardschaden und stärkere Hautverbrennungen verursachen als ein Schock mit niedrigeren monophasischen Energiestufen; dies muss bedacht wer den.…”

Section: Monophasische Impulsformenunclassified

“…Ob wohl ein initialer 360 J Schock den Ge samtenergiebedarf für die Kardioversi on reduziert [185], könnte dieser einen größeren Myokardschaden und stärkere Hautverbrennungen verursachen als ein Schock mit niedrigeren monophasischen Energiestufen; dies muss bedacht wer den. Demzufolge soll bei der Kardioversi on von AF mit einer initialen Energie von 200 J begonnen und nach Bedarf stufen weise gesteigert werden.…”

Section: Monophasische Impulsformenunclassified

Elektrotherapie: automatisierte externe Defibrillatoren, Defibrillation, Kardioversion und Schrittmachertherapie

Deakin

Nolan

Sunde

et al. 2010

Notfall Rettungsmed

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Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity

Aymond,

Sanchez,

Castine

et al. 2024

JAMA Cardiol

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ImportanceAtrial fibrillation and obesity are common, and both are increasing in prevalence. Obesity is associated with failure of cardioversion of atrial fibrillation using a standard single set of defibrillator pads, even at high output.ObjectiveTo compare the efficacy and safety of dual direct-current cardioversion (DCCV) using 2 sets of pads, with each pair simultaneously delivering 200 J, with traditional single 200-J DCCV using 1 set of pads in patients with obesity and atrial fibrillation.Design, Setting, and ParticipantsThis was a prospective, investigator-initiated, patient-blinded, randomized clinical trial spanning 3 years from August 2020 to 2023. As a multicenter trial, the setting included 3 sites in Louisiana. Eligibility criteria included body mass index (BMI) of 35 or higher (calculated as weight in kilograms divided by height in meters squared), age 18 years or older, and planned nonemergent electrical cardioversion for atrial fibrillation. Patients who met inclusion criteria were randomized 1:1. Exclusions occurred due to spontaneous cardioversion, instability, thrombus, or BMI below threshold.InterventionsDual DCCV vs single DCCV.Main Outcomes and MeasuresReturn to sinus rhythm, regardless of duration, immediately after the first cardioversion attempt of atrial fibrillation, adverse cardiovascular events, and chest discomfort after the procedure.ResultsOf 2079 sequential patients undergoing cardioversion, 276 met inclusion criteria and were approached for participation. Of these, 210 participants were randomized 1:1. After exclusions, 200 patients (median [IQR] age, 67.6 [60.1-72.4] years; 127 male [63.5%]) completed the study. The mean (SD) BMI was 41.2 (6.5). Cardioversion was successful more often with dual DCCV compared with single DCCV (97 of 99 patients [98%] vs 87 of 101 patients [86%]; P = .002). Dual cardioversion predicted success (odds ratio, 6.7; 95% CI, 3.3-13.6; P = .01). Patients in the single cardioversion cohort whose first attempt failed underwent dual cardioversion with all subsequent attempts (up to 3 total), all of which were successful: 12 of 14 after second cardioversion and 2 of 14 after third cardioversion. There was no difference in the rating of postprocedure chest discomfort (median in both groups = 0 of 10; P = .40). There were no cardiovascular complications.Conclusions and RelevanceIn patients with obesity (BMI ≥35) undergoing electrical cardioversion for atrial fibrillation, dual DCCV results in greater cardioversion success compared with single DCCV, without any increase in complications or patient discomfort.Trial RegistrationClinicalTrials.gov Identifier: NCT04539158

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Initial energy for elective external cardioversion of persistent atrial fibrillation

Cited by 83 publications

References 9 publications

Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Elektrotherapie: automatisierte externe Defibrillatoren, Defibrillation, Kardioversion und Schrittmachertherapie

Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity

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