Randomised comparison of electrode positions for cardioversion of atrial fibrillation

Abstract

While aetiology and TTI were the two independent significant predictive factors for energy requirement, duration of atrial fibrillation was the only independent predictor of cardioversion success in a multivariate analysis. Conclusions-Electrode pad position is not a determinant of cardioversion success rate or energy requirement.

DC cardioversion of persistent atrial fibrillation: A comparison of two protocols

“…This appears to be discordant to metaanalysis of earlier studies which confirm a higher cardioversion success rate for the anteroposterior vs. anteroapical electrode positions [3,5,15,16]. The patient subset used for sub-analysis in the present study was likely too small for a negative result to be detected with sufficient statistical accuracy.…”

Part 6: Defibrillation

“…Four studies support the anteriorposterior position (LOE 5), 26 -30 1 study supports the anterior-lateral position (LOE 5), 31 and 1 study supports the anterior-apex position (LOE 5). 32 Five studies (LOE 5) 16,[21][22][23][24] found no effect of electrode position on TTI. One study showed that paddles/pads should be placed under the breast tissue (LOE 5) 33 and 2 studies showed that hirsute males should be shaved before the application of pads (LOE 5).…”

“…Most studies evaluate cardioversion (eg, AF) or secondary end points (eg, TTI). Eleven studies (LOE 5) [15][16][17][18][19][20][21][22][23][24][25] found all 4 positions (anterior-apex, anteriorposterior, anterior-left infrascapular, anterior-right infrascapular) to be equally effective in defibrillation (for VF/pulseless VT) or elective AF cardioversion success. Four studies support the anteriorposterior position (LOE 5), 26 -30 1 study supports the anterior-lateral position (LOE 5), 31 and 1 study supports the anterior-apex position (LOE 5).…”

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

“…Previous studies comparing the relative efficacy of pad positions on AF cardioversion have yielded divergent results, with several studies indicating that position has no bearing on cardioversion success 5,6,11) and other studies showing that anteroposterior positioning achieves significantly improved results. [7][8][9][10]12) In the study by Mehdiard, et al 11) 360 J DC shocks with the electrode pads positioned anteroposteriorly (under fluoroscopic guidance) to cover the atrial mass as much as possible were able to successfully induce sinus rhythm in 8 of 15 patients who had failed cardioversion using a conventional pad position. The recent randomized study by Kirchhof, et al 12) also supported the advantage of an anterior-posterior position over the anterior-lateral position for external cardioversion of persistent atrial fibrillation.…”

“…Several studies suggest a higher cardioversion success rate when pads are positioned over the right parasternal area or sternal body and the left infrascapular area, rather than when electrode pads are conventionally positioned. [7][8][9][10] However, the differences in cardioversion success rate due to differing pad positions have not been confirmed by other studies. 5,6,11) Recently, a small, nonrandomized, and nonprospective study by Mehdiard, et al 11) suggested that improved DC cardioversion efficacy in patients with AF could be achieved by positioning pads under fluoroscopy to encompass as much atrial muscle as possible.…”