Monophasic and biphasic shock for transthoracic conversion of atrial fibrillation: Systematic review and network meta-analysis

Inácio, José Francisco Secorun; Rosa, Michele dos Santos Gomes da; Shah, Jatin; Rosário, Jeferson; Vissoci, João Ricardo Nickenig; Manica, André; Rodrigues, Clarissa Garcia

doi:10.1016/j.resuscitation.2015.12.009

Cited by 25 publications

(18 citation statements)

References 25 publications

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“…Whether similar findings would have been observed with other waveforms is unknown. A recent network meta‐analysis found equal ECV efficacy between BTE and rectilinear biphasic waveforms; however, a small study has suggested that ECV using a pulsed biphasic waveform may be less effective than BTE …”

Section: Discussionmentioning

confidence: 98%

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: Discussionmentioning

confidence: 98%

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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“…Until the 90's, direct transthoracic current was delivered using external defibrillators with monophasic waveforms. During the last decades, new biphasic waveforms were designed and their superiority in efficacy and safety was explicitly demonstrated Inácio, 2016;Koster, 2004;Mittal, 2000;Page, 2002). Various biphasic waveforms became an industry standard: rectilinear biphasic (RB), biphasic truncated exponential (BTE) with high energy (HE), low energy (LE) and pulsed energy (PE).…”

Section: Introductionmentioning

confidence: 99%

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

Lavignasse

Trendafilova

Dimitrova

et al. 2019

Journal of Atrial Fibrillation

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“…This was also the case for geriatric patients. Synchronized direct current electric CV (ECV) is more effective than pharmacological CV (PCV) and often results in sinus rhythm (SR) restoration [1,42]. ECV requires sedation which can be achieved by intravenous midazolam and/or propofol, or etomidate [43].…”

Section: Cardioversionmentioning

confidence: 99%

Diagnosis and Therapy of Atrial Fibrillation in Geriatric Patients

Cocco¹,

Amiet²

2021

obm geriatr

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Atrial fibrillation is very common in most old patients who need an adapted therapy due to their comorbidities. Before initiating an antiarrhythmic therapy, possible adverse effects, especially iatrogenic proarrhythmia, and extracardiac side-effects, must be considered. In geriatric patients with atrial fibrillation, heart rate control is the most frequent therapy. Oral anticoagulation plays a vital role in the therapy, but anticoagulation in old patients, who had a bleeding or stroke event, is challenging. Available data favor the use of anticoagulation in old patients with atrial fibrillation and suggest the use of direct oral coagulants, in most cases, over the use of vitamin K antagonists. However, a gap exists in the knowledge regarding the optimal dose in very old patients, particularly in patients with mild-to-moderate renal failure, with very low or high body mass index, and in those receiving medications with a high risk of metabolic interactions.

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Monophasic and biphasic shock for transthoracic conversion of atrial fibrillation: Systematic review and network meta-analysis

Cited by 25 publications

References 25 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

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

Diagnosis and Therapy of Atrial Fibrillation in Geriatric Patients

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