Electrical reversion of cardiac arrhythmias.

Lown, Bernard

doi:10.1136/hrt.29.4.469

Cited by 601 publications

(162 citation statements)

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“…Several studies suggest a higher cardioversion success rate when pads are positioned over the right parasternal area or sternal body and the left infrascapular area, rather than when electrode pads are conventionally positioned. [7][8][9][10] However, the differences in cardioversion success rate due to differing pad positions have not been confirmed by other studies. 5,6,11) Recently, a small, nonrandomized, and nonprospective study by Mehdiard, et al 11) suggested that improved DC cardioversion efficacy in patients with AF could be achieved by positioning pads under fluoroscopy to encompass as much atrial muscle as possible.…”

mentioning

confidence: 63%

“…Previous studies comparing the relative efficacy of pad positions on AF cardioversion have yielded divergent results, with several studies indicating that position has no bearing on cardioversion success 5,6,11) and other studies showing that anteroposterior positioning achieves significantly improved results. [7][8][9][10]12) In the study by Mehdiard, et al 11) 360 J DC shocks with the electrode pads positioned anteroposteriorly (under fluoroscopic guidance) to cover the atrial mass as much as possible were able to successfully induce sinus rhythm in 8 of 15 patients who had failed cardioversion using a conventional pad position. The recent randomized study by Kirchhof, et al 12) also supported the advantage of an anterior-posterior position over the anterior-lateral position for external cardioversion of persistent atrial fibrillation.…”

Section: Discussionmentioning

confidence: 99%

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External Cardioversion in Patients With Persistent Atrial Fibrillation A Reappraisal of the Effects of Electrode Pad Position and Transthoracic Impedance on Cardioversion Success.

Chen

Guo

2003

Jpn Heart J

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SUMMARYThe optimal methods to perform external cardioversion of atrial fibrillation (AF) have yet to be conclusively determined. This study was performed to examine the relative efficacy of different pad positions on cardioversion success and the relationship between the transthoracic impedance (TTI) and energy requirement for AF cardioversion.Seventy patients with persistent AF undergoing elective cardioversion were randomly assigned to an electrode pad position situated either over the ventricular apex-right infraclavicular area (AL group, n = 31) or over the right lower sternal border-left infrascapular area close to the spine (AP group, n = 39). Energy was delivered at an initial 100 joules (J) and then increased to 150 J, 200 J, 300 J, and 360 J if needed. Energy and TTI readings were recorded.Mean TTI was significantly lower in the AP group than in the AL group. However, the cumulative success rates at each energy level were similar in the two groups (23% vs 19.4%, 41% vs 45.2%, 66.7% vs 74.2%, 79.5% vs 77.4%, and 84.6% vs 83.9% at 100 J, 150 J, 200 J, 300 J and 360 J, respectively). In the AP group, converters showed slightly lower TTI compared to nonconverters. In the AL group, converters showed significantly lower TTI compared to nonconverters. However, for all patients as a group, TTI was the only predictor for cardioversion success and showed a significant relationship to the energy required for cardioversion, which can be described by a quadratic equation.Rather than pad position, TTI is the single factor that significantly affects cardioversion and correlates with energy requirement. The relationship between energy requirement and TTI further allows estimation of energy requirements to achieve a successful cardioversion. (Jpn Heart J 2003; 44: 921-932) Key words: Atrial fibrillation, Cardioversion, Impedance, Electrode pad position EXTERNAL direct current (DC) cardioversion, which is useful for cardioversion of atrial fibrillation (AF), has conventionally been performed by delivering an energy shock starting at 100 joules (J) followed by 200 J, 300 J, and 360 J,

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mentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

External Cardioversion in Patients With Persistent Atrial Fibrillation A Reappraisal of the Effects of Electrode Pad Position and Transthoracic Impedance on Cardioversion Success.

Chen

Guo

2003

Jpn Heart J

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“…Only 19% of the procedures depleted the possibilities of the method, using 360J of energy. Several studies had thresholds higher than 200J in up to 74% of the cases [16][17][18] , and probably the success rate would increase if 300 to 360J of energy were attempted in all cases considered unsuccessful. In our study, the use of ≥300J of energy in the cases where previous ≤250J shocks had failed increased the cardioversion rate in 44% of patients.…”

Section: Discussionmentioning

confidence: 99%

Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Figueiredo¹,

Veloso²,

Paola³

2002

Arq. Bras. Cardiol.

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“…Indeed, success rates vary according to the point in time that success is defined. In one series of 1.838 eletrical CV, success rates, when the duration of AF was <30, 30 to 90, 90 to 180, and >180 days was 84, 78, 77, and 66 percent, respectively.53 When AF has been present for more than five years, success rates are only approximately 50 percent [50]. Indications and contraindications of AF/AFL is given in Table 9 [5,6,54,55].…”

Section: Electrical Cardioversion Of Af/afl In Edmentioning

confidence: 99%

“…Electrical CV success rates vary from 75 to 93%. They are inversely related to the AF duration, chest wall impedance, and left atrial size [48][49][50][51][52]. Indeed, success rates vary according to the point in time that success is defined.…”

Section: Electrical Cardioversion Of Af/afl In Edmentioning

confidence: 99%

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

Beton¹,

Yılmaz²,

Korkmaz³

et al. 2014

Cumhuriyet Med J

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Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice. One-third of hospitalizations for cardiac rhythm disturbances are attributed to AF, with increasing rates in the past decade. Significant morbidity and mortality, including 15% to 20% of all ischemic strokes and 20% of all strokes, result from AF. The overall mortality rate for patients with AF is approximately double that for patients in normal sinus rhythm. Atrial flutter (AFL) has many clinical aspects that are similar to AF, AF and AFL have same management strategies in emergency settings. The major goals of treatment include alleviation of the associated symptoms and/or hemodynamic disturbance, reduction of the risk of systemic thromboembolism, reduction in hospital length of stay. The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control (cardioversion), but did not explore the optimal management for recent-onset AF/AFL patients presenting to the emergency department (ED) with in 48 hours of symptoms. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy (rate or rhythm) chosen. National based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem. Aim of this review is to give detailed information for ED team about echocardiographic criterias supporting cardioversion (CV) of AF, CV procedure itself and new antiarrhythmic and oral anticoagulant drugs by adhering to the guidelines. Keywords: Cardioversion, recent-onset atrial fibrillation, flutter, emergency ÖzetAtriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15-%20'si ve tüm inmelerin %20'si AF nedenlidir. AF'si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)'in AF'e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS'de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS'de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak...

show abstract

Electrical reversion of cardiac arrhythmias.

Cited by 601 publications

References 54 publications

External Cardioversion in Patients With Persistent Atrial Fibrillation A Reappraisal of the Effects of Electrode Pad Position and Transthoracic Impedance on Cardioversion Success.

External Cardioversion in Patients With Persistent Atrial Fibrillation A Reappraisal of the Effects of Electrode Pad Position and Transthoracic Impedance on Cardioversion Success.

Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

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