Cardioversion for atrial fibrillation: Efficacy of dose-response of low energy, high energy and pulsed biphasic truncated exponential waveforms

A Randomized Comparison of Delivered Energy in Cardioversion of Atrial Fibrillation: Biphasic Truncated Exponential Versus Pulsed Biphasic Waveforms

“…Elective CVS of AF with fixed energy protocol (200-200-200 J) was similarly effective in both arms ( p > 0.05), reaching >94% success rate for restoration of sinus rhythm at least 24 h after CVS with PB waveform. Considering literature survey findings that CVS dose–response curves concentrate within an efficacy range of 85–95% and mean cumulative energy range of 300–500 J [ 32 ], this study neared the upper limit of efficacy range while lowering the threshold of mean cumulative energies to 226 J (PB) and 254 J (BTE-HE). In particular, when compared to two other CVS studies using PB waveforms, the reported success rate of 94.2% (24 h) was similar to 95.4% (1 min) [ 13 ] and higher than 67% (4 h) [ 12 ], the latter performed with a defective device, and the results of which should be interpreted with caution.…”

“…Scarce clinical trials have been found to study the efficacy and safety of PB waveform in CVS [ 12 , 13 , 17 ]. A systematic literature review on CVS efficacy [ 32 ] demonstrates that the dose–response curves of PB, BTE with high energy (BTE-HE) [ 10 , 11 , 12 ] and BTE with low energy (BTE-LE) [ 8 , 15 ] concentrate within 85–95% success rate and 300–500 J cumulative energy, despite major disparities found between published studies (success definition, rhythm inhomogeneity, different population sizes, different selected energy levels, etc.). The validity of significantly deviating efficacy of PB waveform in one of the surveyed studies is questionable [ 12 ], linked to the use of a defective device.…”