Cardioversion of Atrial Fibrillation and Flutter: Comparative Study of Pulsed vs. Low Energy Biphasic Truncated Exponential Waveforms

Lavignasse, Delphine; Trendafilova, Elina; Dimitrova, Elena; Krasteva, Vessela

doi:10.4022/jafib.2172

Cited by 3 publications

(9 citation statements)

References 25 publications

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“…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. A major difference between studies was the used energy protocol: low-escalating [ 12 , 13 ] and fixed (this study).…”

Section: Discussionsupporting

confidence: 57%

“…A few clinical CVS trials have compared the efficacy and safety of biphasic defibrillators using industry standard waveforms, namely rectilinear biphasic (RB), biphasic truncated exponential (BTE) or pulsed biphasic (PB) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Impedance compensation of all defibrillation waveforms is required by standards, which tolerate a deviation of ±15% in delivered energy [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the efficacy analysis is important to consider the real-life pulse characteristics and energy deviation which can be accurately measured [ 19 , 20 , 25 , 26 ]. At the same time, the efficacy analysis should take into account different definitions of CVS success, which varies from post-shock restoration of sinus rhythm at 5 s [ 9 , 11 ], 30 s [ 15 ] to 4 h [ 12 ], and most often 1 min [ 8 , 10 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…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.).…”

Section: Introductionmentioning

confidence: 99%

“…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. Indeed, our recent CVS trial demonstrates no superiority of BTE-LE over PB waveform with an excellent safety profile without post-shock myocardial injuries [ 13 ]. More data from randomized studies, assessing the efficacy and safety of PB waveform, are required according to international guidelines [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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A few randomized trials have compared impedance-compensated biphasic defibrillators in clinical use. We aim to compare pulsed biphasic (PB) and biphasic truncated exponential (BTE) waveforms in a non-inferiority cardioversion (CVS) study. This was a prospective monocentric randomized clinical trial. Eligible patients admitted for elective CVS of atrial fibrillation (AF) between February 2019 and March 2020 were alternately randomized to treatment with either a PB defibrillator (DEFIGARD TOUCH7, Schiller Médical, Wissembourg, France) or a BTE high-energy (BTE-HE) defibrillator (LIFEPAK15, Physio-Control Inc., Redmond, WA, USA). Fixed-energy protocol (200–200–200 J) was administered. CVS success was accepted if sinus rhythm was restored at 1 min post-shock. The study design considered non-inferiority testing of the primary outcome: cumulative delivered energy (CDE). Seventy-three out of 78 randomized patients received allocated intervention: 38 BTE-HE (52%), 35 PB (48%). Baseline characteristics were well-balanced between groups (p > 0.05). Both waveforms had similar CDE (mean ± standard deviation, 95% confidence interval): BTE-HE (253.9 ± 120.2 J, 214–293 J) vs. PB (226.0 ± 109.8 J, 188–264 J), p = 0.31. Indeed, effective PB shocks delivered significantly lower energies by mean of 25.6 J (95% CI 24–27.1 J, p < 0.001). Success rates were similar (BTE-HE vs. PB): 1 min first-shock (84.2% vs. 82.9%), 1 min CVS (97.4% vs. 94.3%), 2 h CVS (94.7% vs. 94.3%), 24 h CVS (92.1% vs. 94.3%), p > 0.05. Safety analysis did not find CVS hazards, reporting insignificant changes of myocardial-specific biomarkers, transient and rare ST-segment deviations, and no case of harmful tachyarrhythmias and apnea. Cardioversion of AF with fixed-energy protocol 200–200–200 J was highly efficient and safe for both PB and BTE-HE waveforms. These similar performances were achieved despite differences in the waveforms’ technical design, associated with significantly lower delivered energy for the effective PB shocks. Clinical Trial Registration: Registration number: NCT04032678, trial register: ClinicalTrials.gov.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity

Aymond,

Sanchez,

Castine

et al. 2024

JAMA Cardiol

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ImportanceAtrial fibrillation and obesity are common, and both are increasing in prevalence. Obesity is associated with failure of cardioversion of atrial fibrillation using a standard single set of defibrillator pads, even at high output.ObjectiveTo compare the efficacy and safety of dual direct-current cardioversion (DCCV) using 2 sets of pads, with each pair simultaneously delivering 200 J, with traditional single 200-J DCCV using 1 set of pads in patients with obesity and atrial fibrillation.Design, Setting, and ParticipantsThis was a prospective, investigator-initiated, patient-blinded, randomized clinical trial spanning 3 years from August 2020 to 2023. As a multicenter trial, the setting included 3 sites in Louisiana. Eligibility criteria included body mass index (BMI) of 35 or higher (calculated as weight in kilograms divided by height in meters squared), age 18 years or older, and planned nonemergent electrical cardioversion for atrial fibrillation. Patients who met inclusion criteria were randomized 1:1. Exclusions occurred due to spontaneous cardioversion, instability, thrombus, or BMI below threshold.InterventionsDual DCCV vs single DCCV.Main Outcomes and MeasuresReturn to sinus rhythm, regardless of duration, immediately after the first cardioversion attempt of atrial fibrillation, adverse cardiovascular events, and chest discomfort after the procedure.ResultsOf 2079 sequential patients undergoing cardioversion, 276 met inclusion criteria and were approached for participation. Of these, 210 participants were randomized 1:1. After exclusions, 200 patients (median [IQR] age, 67.6 [60.1-72.4] years; 127 male [63.5%]) completed the study. The mean (SD) BMI was 41.2 (6.5). Cardioversion was successful more often with dual DCCV compared with single DCCV (97 of 99 patients [98%] vs 87 of 101 patients [86%]; P = .002). Dual cardioversion predicted success (odds ratio, 6.7; 95% CI, 3.3-13.6; P = .01). Patients in the single cardioversion cohort whose first attempt failed underwent dual cardioversion with all subsequent attempts (up to 3 total), all of which were successful: 12 of 14 after second cardioversion and 2 of 14 after third cardioversion. There was no difference in the rating of postprocedure chest discomfort (median in both groups = 0 of 10; P = .40). There were no cardiovascular complications.Conclusions and RelevanceIn patients with obesity (BMI ≥35) undergoing electrical cardioversion for atrial fibrillation, dual DCCV results in greater cardioversion success compared with single DCCV, without any increase in complications or patient discomfort.Trial RegistrationClinicalTrials.gov Identifier: NCT04539158

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The Application of Artificial Intelligence in Atrial Fibrillation Patients: From Detection to Treatment

Liang,

Zhang,

Wang

et al. 2024

Rev. Cardiovasc. Med.

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Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide. Although the guidelines for AF have been updated in recent years, its gradual onset and associated risk of stroke pose challenges for both patients and cardiologists in real-world practice. Artificial intelligence (AI) is a powerful tool in image analysis, data processing, and for establishing models. It has been widely applied in various medical fields, including AF. In this review, we focus on the progress and knowledge gap regarding the use of AI in AF patients and highlight its potential throughout the entire cycle of AF management, from detection to drug treatment. More evidence is needed to demonstrate its ability to improve prognosis through high-quality randomized controlled trials.

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Cardioversion of Atrial Fibrillation and Flutter: Comparative Study of Pulsed vs. Low Energy Biphasic Truncated Exponential Waveforms

Abstract: Material and Methods Study population This is a retrospective and monocentric trial, evaluating the results www.jafib.com Oct-Nov 2019| Volume 12| Issue 3

Cited by 3 publications

References 25 publications

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

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

Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity

The Application of Artificial Intelligence in Atrial Fibrillation Patients: From Detection to Treatment

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