Initial energy setting, outcome and efficiency in direct current cardioversion of atrial fibrillation and flutter

Gallagher, Mark M.; Guo, Xiang-Zhao; Poloniecki, Jan; Yap, Yee Guan; Ward, David; Camm, A. John

doi:10.1016/s0735-1097(01)01540-6

Cited by 89 publications

(49 citation statements)

References 15 publications

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“…With 360 J of shock, we achieved an 84% success rate. We did not find, as Gallagaher, et al 23) did in their study, that AF duration affects the energy requirement. Thus, based on their and our results, it is reasonable to start with a 200 J shock, as this level of energy is capable of achieving a reasonable AF conversion success rate, supporting the recent recommendations for electrical cardioversion of atrial fibrillation.…”

Section: )contrasting

confidence: 75%

“…20,21) Other studies have suggested that 360 J, or 200 J at a minimun, should be used as an initial energy level for elective cardioversion of persistent AF. 22,23) Gallagher, et al 23) even reported that, for patients with AF for more than 30 days, shocks of < 200 J simply were a waste of time. They observed that in patients with AF for > 180 days, an initial setting of ≥ 300 J reduced the total energy used but achieved a modest success rate of 56%.…”

Section: )mentioning

confidence: 99%

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

Chen

Guo

2003

Jpn Heart J

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SUMMARYThe optimal methods to perform external cardioversion of atrial fibrillation (AF) have yet to be conclusively determined. This study was performed to examine the relative efficacy of different pad positions on cardioversion success and the relationship between the transthoracic impedance (TTI) and energy requirement for AF cardioversion.Seventy patients with persistent AF undergoing elective cardioversion were randomly assigned to an electrode pad position situated either over the ventricular apex-right infraclavicular area (AL group, n = 31) or over the right lower sternal border-left infrascapular area close to the spine (AP group, n = 39). Energy was delivered at an initial 100 joules (J) and then increased to 150 J, 200 J, 300 J, and 360 J if needed. Energy and TTI readings were recorded.Mean TTI was significantly lower in the AP group than in the AL group. However, the cumulative success rates at each energy level were similar in the two groups (23% vs 19.4%, 41% vs 45.2%, 66.7% vs 74.2%, 79.5% vs 77.4%, and 84.6% vs 83.9% at 100 J, 150 J, 200 J, 300 J and 360 J, respectively). In the AP group, converters showed slightly lower TTI compared to nonconverters. In the AL group, converters showed significantly lower TTI compared to nonconverters. However, for all patients as a group, TTI was the only predictor for cardioversion success and showed a significant relationship to the energy required for cardioversion, which can be described by a quadratic equation.Rather than pad position, TTI is the single factor that significantly affects cardioversion and correlates with energy requirement. The relationship between energy requirement and TTI further allows estimation of energy requirements to achieve a successful cardioversion. (Jpn Heart J 2003; 44: 921-932) Key words: Atrial fibrillation, Cardioversion, Impedance, Electrode pad position EXTERNAL direct current (DC) cardioversion, which is useful for cardioversion of atrial fibrillation (AF), has conventionally been performed by delivering an energy shock starting at 100 joules (J) followed by 200 J, 300 J, and 360 J,

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Section: )contrasting

confidence: 75%

Section: )mentioning

confidence: 99%

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

Chen

Guo

2003

Jpn Heart J

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“…70,71 Transthoracic direct-current cardioversion, under short-lasting sedation, is the quickest and most effective method to recover sinus rhythm in patients with flutter, with a lower energy delivery and higher success rate than in AF. 72,73 In 50-80 % of cases flutter interruption can be achieved by atrial pacing above the flutter rate through a transvenous catheter, through epicardial electrodes placed during cardiac surgery 8 or by programming fast atrial rates in patients with atrial or dual-chamber pacemakers. 74 Pacing runs of 20-30 s are started at a rate 10 bpm higher than flutter, increasing in 10 bpm steps up to 400 bpm or until flutter is interrupted and sinus (or paced) atrial rhythm is established (see Figure 6).…”

Section: 69mentioning

confidence: 99%

Atrial Flutter, Typical and Atypical: A Review

Cosío

2017

Arrhythmia &Amp; Electrophysiology Review

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Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

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“…Electrical CV success rates vary from 75 to 93%. They are inversely related to the AF duration, chest wall impedance, and left atrial size [48][49][50][51][52]. Indeed, success rates vary according to the point in time that success is defined.…”

Section: Electrical Cardioversion Of Af/afl In Edmentioning

confidence: 99%

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

Beton¹,

Yılmaz²,

Korkmaz³

et al. 2014

CMJ

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Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice. One-third of hospitalizations for cardiac rhythm disturbances are attributed to AF, with increasing rates in the past decade. Significant morbidity and mortality, including 15% to 20% of all ischemic strokes and 20% of all strokes, result from AF. The overall mortality rate for patients with AF is approximately double that for patients in normal sinus rhythm. Atrial flutter (AFL) has many clinical aspects that are similar to AF, AF and AFL have same management strategies in emergency settings. The major goals of treatment include alleviation of the associated symptoms and/or hemodynamic disturbance, reduction of the risk of systemic thromboembolism, reduction in hospital length of stay. The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control (cardioversion), but did not explore the optimal management for recent-onset AF/AFL patients presenting to the emergency department (ED) with in 48 hours of symptoms. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy (rate or rhythm) chosen. National based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem. Aim of this review is to give detailed information for ED team about echocardiographic criterias supporting cardioversion (CV) of AF, CV procedure itself and new antiarrhythmic and oral anticoagulant drugs by adhering to the guidelines. Keywords: Cardioversion, recent-onset atrial fibrillation, flutter, emergency ÖzetAtriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15-%20'si ve tüm inmelerin %20'si AF nedenlidir. AF'si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)'in AF'e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS'de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS'de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak...

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Initial energy setting, outcome and efficiency in direct current cardioversion of atrial fibrillation and flutter

Abstract: An initial energy setting of > or =360 J can achieve cardioversion of AF more efficiently in patients than traditional protocols, particularly with AF of longer duration.

Cited by 89 publications

References 15 publications

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

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

Atrial Flutter, Typical and Atypical: A Review

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

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