Anterior-Posterior versus anterior-lateral electrodes position for electrical cardioversion of atrial fibrillation: A meta-analysis of randomized controlled trials
“…3 Yet, more systematic reviews with meta-analyses of randomised controlled trials (RCTs) have recently examined the optimal electrode position for cardioverting AF, but the results are conflicting. [6][7][8][9][10][11] Lately, attention has…”
ObjectiveElectrode patch position may not be critical for success when cardioverting atrial fibrillation (AF), but the relevance of applied electrical energy is unclarified. Our objective was to perform a meta-analysis of randomised trials to examine the dose–response relation between energy level and cardioversion success by electrode position in elective cardioversion.MethodsWe searched PubMed, Embase, The Cochrane Library, Google Scholar and Scopus Citations. Inclusion criteria were randomised controlled trials using biphasic shock waves and self-adhesive patches, and publication date from 2000 to 2023. We used random-effects dose-response models to meta-analyse the relation between energy level and cardioversion success by anterolateral and anteroposterior position. Random-effects models estimated pooled risk ratios (RR) for cardioversion success after the first and the final shocks between the two electrode positions.ResultsWe included five randomised controlled trials (N=1078). After the first low-energy shock, the electrode position was not significantly associated with the likelihood of successful cardioversion (pooled RR anterolateral vs anteroposterior placement 1.28, 95% CI 0.93 to 1.76, with considerable heterogeneity). After a high-energy final shock, there was no evidence of an association between the electrode position and the cumulative chance of cardioversion success (pooled RR anterolateral vs anteroposterior 1.05, 95% CI 0.97 to 1.14). Regardless of electrode position, cardioversion success was significantly less likely with shock energy levels < 200J compared with 200J.ConclusionEvidence from contemporary randomised trials suggests that higher level of electrical energy is associated with higher conversion rate when cardioverting AF with a biphasic shockwave. Positioning of electrodes can be based on convenience.
“…3 Yet, more systematic reviews with meta-analyses of randomised controlled trials (RCTs) have recently examined the optimal electrode position for cardioverting AF, but the results are conflicting. [6][7][8][9][10][11] Lately, attention has…”
ObjectiveElectrode patch position may not be critical for success when cardioverting atrial fibrillation (AF), but the relevance of applied electrical energy is unclarified. Our objective was to perform a meta-analysis of randomised trials to examine the dose–response relation between energy level and cardioversion success by electrode position in elective cardioversion.MethodsWe searched PubMed, Embase, The Cochrane Library, Google Scholar and Scopus Citations. Inclusion criteria were randomised controlled trials using biphasic shock waves and self-adhesive patches, and publication date from 2000 to 2023. We used random-effects dose-response models to meta-analyse the relation between energy level and cardioversion success by anterolateral and anteroposterior position. Random-effects models estimated pooled risk ratios (RR) for cardioversion success after the first and the final shocks between the two electrode positions.ResultsWe included five randomised controlled trials (N=1078). After the first low-energy shock, the electrode position was not significantly associated with the likelihood of successful cardioversion (pooled RR anterolateral vs anteroposterior placement 1.28, 95% CI 0.93 to 1.76, with considerable heterogeneity). After a high-energy final shock, there was no evidence of an association between the electrode position and the cumulative chance of cardioversion success (pooled RR anterolateral vs anteroposterior 1.05, 95% CI 0.97 to 1.14). Regardless of electrode position, cardioversion success was significantly less likely with shock energy levels < 200J compared with 200J.ConclusionEvidence from contemporary randomised trials suggests that higher level of electrical energy is associated with higher conversion rate when cardioverting AF with a biphasic shockwave. Positioning of electrodes can be based on convenience.
“…The systematic review summarized here included RCTs comparing AP and AL pad positioning during elective electrical AF cardioversion 9 . To be included, RCTs had to report cardioversion success rate, which was the primary outcome.…”
Section: Narrativementioning
confidence: 99%
“…The meta‐analysis identified 10 RCTs with 1677 subjects (831 AP, 846 AL) 9 . Two trials were multicenter 4,8 .…”
Section: Narrativementioning
confidence: 99%
“…[4][5][6][7][8] The systematic review summarized here included RCTs comparing AP and AL pad positioning during elective electrical AF cardioversion. 9 To be included, RCTs had to report cardioversion success rate, which was the primary outcome. Other outcomes included cardioversion success at low energy (≤200 J monophasic or ≤120 J biphasic), total number of shocks, mean transthoracic impedance, and mean shock energy.…”
Brass Tacks are concise reviews of published evidence. This series is a result of collaboration between Academic Emergency Medicine and the evidence-based medicine website "www.TheNNT.com." For inquiries please contact the section editor, Shahriar Zehtabchi, MD (email: mshahriar.zehtabchi@ downstate.edu).
“…Educating clinical staff to identify patients with an ILR prior to cardioversion and appropriately placing external defibrillator pads for cardioversion away from the ILR are essential. Recent data by Eid and colleagues 3 showed pad placement, anterior-posterior or anterior-lateral, had no difference in the success rates of AF conversion to sinus rhythm in patients undergoing direct current cardioversions. Figure 1 Device alerts.…”
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