Randomized comparison of anterolateral versus anteroposterior electrode position for biphasic external cardioversion of atrial fibrillation

Siaplaouras, Stephanos; Buob, Axel; Rötter, Carsten; Böhm, Michael; Jung, Jens

doi:10.1016/j.ahj.2004.08.009

Cited by 20 publications

(22 citation statements)

References 18 publications

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“…Twenty‐five studies were selected as potentially relevant and accessed for full‐text review, and the remaining 763 studies were excluded for various reasons. Twelve studies were excluded after full‐text review, while the remaining 13 studies were included in the review involving 836 patients receiving A‐P and 856 patients receiving A‐L pad placement . One of the included studies was only found in the bibliography of several included studies.…”

Section: Resultsmentioning

confidence: 99%

“…One study administered shocks based on the patients' weights, while the remaining studies administered shocks at predetermined energy levels. Overall, monophasic waveforms were used in seven studies, five studies involved biphasic, and one study analyzed both waveform devices . In six studies, if normal sinus rhythm was not restored by the end of the shock protocol, patients received an additional crossover shock in the alternate pad position .…”

Section: Resultsmentioning

confidence: 99%

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The Efficacy of Pad Placement for Electrical Cardioversion of Atrial Fibrillation/Flutter: A Systematic Review

Kirkland

Stiell

AlShawabkeh

et al. 2014

Academic Emergency Medicine

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Objectives: Electrical cardioversion is commonly used to treat patients with atrial fibrillation and atrial flutter to restore normal sinus rhythm. There has been considerable debate as to whether the electrode placement affects the efficacy of electrical cardioversion. The objective of this study was to examine the effectiveness of anteroposterior (A-P) versus anterolateral (A-L) electrode placement to restore normal sinus rhythm.Methods: A search of eight electronic databases, including Medline, EMBASE, CINAHL, and Cochrane was completed. Grey literature (hand-searching, Google, and SCOPUS) searching was also conducted. Studies were included if they were controlled clinical trials comparing the effectiveness of A-P versus A-L pad placement to restore normal sinus rhythm in adult patients with atrial fibrillation and flutter. Two independent reviewers judged study relevance, inclusion, and quality (e.g., risk of bias). Individual and pooled statistics were calculated as relative risks (RRs) with 95% confidence intervals (CIs) using a random-effects model, and heterogeneity (I 2 ) was reported.Results: From 788 citations, 13 studies were included; seven involved monophasic, five involved biphasic, and one analyzed both waveform devices. The included studies tended to report cumulative success rates to restoring normal sinus rhythm after one to five sequential shocks of increasing energy; the number of shocks and energy used differed among studies. The risk of bias of the studies was "unclear." After the first shock, pad placement was not associated with an increased likelihood of restoring normal sinus rhythm (RR = 0.88; 95% CI = 0.73 to 1.06); however, heterogeneity was high (I 2 = 63%). Subgroup comparisons revealed that the A-L position was more effective (RR = 0.77; 95% CI = 0.59 to 1.00) at restoring normal sinus rhythm when using biphasic shocks (comparison p = 0.04). Overall, the pooled results failed to identify a difference between A-P and A-L pad placement in restoring normal sinus rhythm at any time (RR = 1.00; 95% CI = 0.95 to 1.05); however, heterogeneity was high (I 2 = 61%). No significant subgroup differences were found. Side effects were reported in only three studies. Conclusions:The published literature is restricted to persistent atrial fibrillation and atrial flutter, pad placement varied, and energy levels used were lower than currently recommended; however, the accumulated evidence suggests that electrical pad placement is not a critically important factor in successful cardioversion in atrial fibrillation and flutter (AF/AFL). A trial is urgently needed in recentonset atrial fibrillation and atrial flutter patients using biphasic devices and high energy levels to resolve the debate.ACADEMIC EMERGENCY MEDICINE 2014;21:717-726

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Efficacy of Pad Placement for Electrical Cardioversion of Atrial Fibrillation/Flutter: A Systematic Review

Kirkland

Stiell

AlShawabkeh

et al. 2014

Academic Emergency Medicine

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“…First, the mice were treated for 35 days, which is shorter than both the duration that humans receive antiretroviral drugs as well the development of atherosclerosis in humans; however, Shankar et al, 2005 showed endothelial dysfunction in only 4 weeks in healthy, HIV negative subjects who received the antiretroviral indinavir daily for that period, which suggest that HAART can induce changes in subjects within weeks. Another limitation is that the dosage of AZT administered was approximately 10 times higher than the human dose; note, however, that the half-life of AZT in the plasma of mice is around 5 times less than that of humans (Tan and Boudinot, 2000) and this dosage and time course was previously published; thus our methods are consistent with previous work (Sutliff et al, 2002; Lewis et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular complications include increased incidence of myocardial infarction (Friis-Møller et al, 2003; Mary-Krause et al, 2003; Holmberg et al, 2002) and atherosclerotic lesions (Maggi et al, 2004; Spieker et al, 2005) and elevated preclinical markers of atherosclerosis (e.g., increased carotid intima-media thickness (c-IMT) (van Vonderen et al, 2009; Hsue et al, 2004; Ross et al, 2008), arterial stiffening (van Vonderen et al, 2009; Bonnet et al, 2004; Sevastianova et al, 2005), and impaired flow mediated dilation (FMD) (Bonnet et al, 2004; Calmy et al, 2009; Shankar et al, 2005). Antiretrovirals are typically prescribed in cocktails of three drugs; thus, the roles of specific HAART drugs in the development of atherosclerosis are difficult to determine from clinical data (Lundgren et al, 2008; Worm et al, 2010); viral infection may also play a significant role, further complicating the interpretation of clinical data (Oliviero et al, 2009; Hsue et al, 2009; El-Sadr et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Azidothymidine (AZT) leads to arterial stiffening and intima-media thickening in mice

Hansen

Parker

Roberts

et al. 2013

Journal of Biomechanics

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HIV positive patients on highly active antiretroviral therapy (HAART) have shown elevated incidence of a number of non-AIDS defining co-morbidities, including cardiovascular disease. Given that HAART regimens contain a combination of at least three drugs, that disease management often requires adjustment of these regimens, and HIV, independent of HAART, also plays a role in development of co-morbidities, determining the role of specific HAART drugs and HIV infection itself from clinical data remains challenging. To characterize specific mediators and underlying mechanisms of disease, in vitro and in vivo animal models are required, in parallel with clinical data. Given its low cost azidothymidine (AZT) contributes to the backbone of a large proportion of HAART treated patients in the developing world where much of the global burden of HIV resides. The goal of this study was to test the hypothesis that AZT can lead to proatherogenic changes including the subclinical markers of arterial stiffening and intima-media thickening in mice. AZT (100 mg/kg) or vehicle was administered to wild-type FVB/N mice via oral gavage for 35 days. Cylindrical biaxial biomechanical tests on the common carotid arteries and suprarenal aortas exhibited arterial stiffening in AZT mice compared to controls. Multiphoton microscopy and histology demonstrated that AZT led to increased intima-media thickness. These data correlated with decreased elastin content and increased protease activity as measured by cathepsin zymography; no differences were observed in collagen content or organization, in vivo axial stretch, or opening angle. Thus, this study suggests the drug AZT has significant effects on the development of subclinical markers of atherosclerosis.

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“…Lown originally advocated that the anteroposterior position is superior because it requires less energy to reverse AF 52. Some studies have confirmed this notion,53,54 whereas others have shown no advantage to either paddle position 55,56. Because only ≈4% to 5% of the shocking energy actually reaches the heart,57 minor deviation of this electric field probably has little effect on the final outcome.…”

Section: Presentmentioning

confidence: 99%

Cardioversion

2009

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Randomized comparison of anterolateral versus anteroposterior electrode position for biphasic external cardioversion of atrial fibrillation

Cited by 20 publications

References 18 publications

The Efficacy of Pad Placement for Electrical Cardioversion of Atrial Fibrillation/Flutter: A Systematic Review

The Efficacy of Pad Placement for Electrical Cardioversion of Atrial Fibrillation/Flutter: A Systematic Review

Azidothymidine (AZT) leads to arterial stiffening and intima-media thickening in mice

Cardioversion

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