Effect of Applying Force to Self‐Adhesive Electrodes on Transthoracic Impedance: Implications for Electrical Cardioversion

Ramirez, F. Daniel; Fiset, Sandra L.; Cleland, Mark J.; Zakutney, Timothy J.; Nery, Pablo B.; Nair, Girish M.; Redpath, Calum J.; Sadek, Mouhannad M.; Birnie, David H.

doi:10.1111/pace.12937

Cited by 19 publications

(27 citation statements)

References 26 publications

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“…In patients undergoing ECV for AF with contemporary biphasic defibrillators, higher TTI was associated with worse ECV outcomes, including a greater number of shocks, greater cumulative energy requirements, and procedural failure. American guidelines suggest applying pressure to electrodes to reduce TTI; however, few physicians know to do this even when using handheld paddles, and there is no protocol that has been agreed upon for routine AF ECV. Whether strategies to reduce TTI during AF ECV with biphasic defibrillators can improve procedural success is unknown and warrants further study.…”

Section: Resultsmentioning

confidence: 99%

“…Given the de‐identified nature of the data, we were unable to account for patient and procedural characteristics that could confound or modify the associations between TTI and ECV outcomes. For instance, certain anthropometric measures may explain the relationships observed . Nevertheless, TTI would still be a marker of patients in whom ECV outcomes are suboptimal.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in patient characteristics, patient preparation (including electrode placement and therefore shock vectors), starting energy, and in defibrillators used may have also contributed to differences observed. 10,15,[20][21][22]…”

Section: Discussionmentioning

confidence: 99%

“…For instance, certain anthropometric measures may explain the relationships observed. 11,20,23 Nevertheless, TTI would still be a marker of patients in whom ECV outcomes are suboptimal. Though our data are from a single center, the considerable variability in starting energy and shock energy escalation suggests nonuniform practices, which is consistent with the variability in ECV techniques seen at other centers.…”

Section: Study Limitationsmentioning

confidence: 99%

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Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter

Sadek

Chaugai

Cleland

et al. 2018

Clinical Cardiology

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Background The relevance of transthoracic impedance (TTI) to electrical cardioversion (ECV) success for atrial tachyarrhythmias when using biphasic waveform defibrillators is unknown. Hypothesis TTI is predictive of ECV success with contemporary defibrillators. Methods De‐identified data stored in biphasic defibrillator memory cards from ECV attempts for atrial fibrillation (AF) or atrial flutter (AFL) over a 2‐year period at our center were evaluated. ECV success, defined as arrhythmia termination and ≥ 1 sinus beat, was adjudicated by 2 blinded cardiac electrophysiologists. The association between TTI and ECV success was assessed via Cochrane‐Armitage trend and Spearman rank correlation tests, as well as simple and multivariable logistic regression. The influence of TTI on the number of shocks and on cumulative energy delivered per patient was also examined. Results 703 patients (593 with AF, 110 with AFL) receiving 1055 shocks were included. Last shock success was achieved in 88.0% and 98.2% of patients with AF and AFL, respectively. In patients with AF, TTI was positively associated with last shock failure (Ptrend =0.019), the need for multiple shocks (Ptrend <0.001), and cumulative energy delivered (ρ = 0.348; P < 0.001). After adjusting for first shock energy, 10‐Ω increments in TTI were associated with odds ratios of 1.36 (95% CI: 1.24–1.49) and 1.22 (95% CI: 1.09–1.37) for first and last shock failure, respectively (P < 0.001 for both). Conclusions Although contemporary defibrillators are designed to compensate for TTI, this variable continues to be associated with ECV failure in patients with AF. Strategies to lower TTI during ECV for AF may improve procedural success.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

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Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter

Sadek

Chaugai

Cleland

et al. 2018

Clinical Cardiology

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“…Prior to trying novel cardioversion methods, the practitioner should ensure that standard techniques have been optimized. 4,21,22 Moreover, devices may not be designed or tested to withstand DSSC, and damage has been reported to occur. 23…”

Section: Discussionmentioning

confidence: 99%

Double sequential cardioversion for refractory ventricular tachycardia: A case report

Sheikh

Xie

Austin

2018

CJEM

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Sustained monomorphic ventricular tachycardia (VT) can result in hypoperfusion or devolve into more dangerous rhythms such as ventricular fibrillation. In an unstable patient with VT and a pulse, synchronized cardioversion is the first-line treatment. When the VT is refractory to standard cardioversion, the next step is to add an antiarrhythmic, such as amiodarone, that carries with it the risk of lowering blood pressure in the already hypotensive patient. Here we describe a case of double sequential synchronized cardioversion of a patient with unstable VT refractory to standard direct current cardioversion, resulting in a rapid conversion to sinus rhythm and return to hemodynamic stability. The benefit of this technique is that it may obviate the need for rapid infusion of medications, such as amiodarone, in the acute setting that may worsen hypotension in the already unstable patient.

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Cardioversion: The Breadth of Efficacy

Reiffel¹

2023

The American Journal of Cardiology

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Effect of Applying Force to Self‐Adhesive Electrodes on Transthoracic Impedance: Implications for Electrical Cardioversion

Abstract: Applying force to self-adhesive electrodes reduces TTI and should be considered as a means of improving ECV success. Numerically greater mean force applied with a "push-up" force analogy suggests that "concrete" cues may be useful in improving ECV technique.

Cited by 19 publications

References 26 publications

Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter

Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter

Double sequential cardioversion for refractory ventricular tachycardia: A case report

Cardioversion: The Breadth of Efficacy

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