Prospective Assessment of the Minimum Energy Needed for External Electrical Cardioversion of Atrial Fibrillation

Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

“…This fact could explain the differences found, with a reduction in the number of shocks and a tendency toward greater efficacy of the initial shock in the ≥150J group. However, our data are in accordance with the studies that compared initial energy levels for elective electrical cardioversion of atrial fibrillation [19][20][21] .…”

“…In patients with chronic atrial fibrillation (lasting >48h), the number of shocks administered was lower in the ≥150J group, similar to that in the total group. Although these data are limited due to the restricted number of patients in each subgroup, they are in accordance with previous studies that showed the relation between the immediate success of electrical cardioversion and the duration of arrhythmia 20 . The authors of this study concluded that 100J of energy may be appropriate for patients with recent-onset atrial fibrillation (lasting <24h); however, it can be very low for electrical cardioversion of patients with longer episodes of arrhythmia.…”

“…Sermasi et al 19 did not find differences in final cardioversion rates (87% in the 100J group and 85% in the 200J group). Likewise, Joglar et al 20 reported similar final efficacy between the groups studied (90% in the 100 and 200J groups and 100% in the 360J group).…”

“…In a nonrandomized study, Sermasi et al 19 compared groups that received 100 and 200J of initial energy and observed that higher initial energy resulted in greater efficacy of the initial shock (36% versus 13%). Ricard et al 20 , in a nonrandomized prospective study in patients with atrial fibrillation lasting more than 24 hours, reported success rates of 22%, 48%, 75%, and 96% with 40 to 50J, 80 to 100J, 160 to 200J, and 360J, respectively. Joglar et al 21 , in the only randomized study for the assessment of initial energy of elective cardioversion of atrial fibrillation, also had higher efficacy of shocks using higher initial energy levels: cardioversion rates were 14% with 100J, 39% with 200J, and 90% with 360J.…”

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

“…This figure rises to about 75-85% when a 200 J shock is then administered. 20,21) Other studies have suggested that 360 J, or 200 J at a minimun, should be used as an initial energy level for elective cardioversion of persistent AF. 22,23) Gallagher, et al 23) even reported that, for patients with AF for more than 30 days, shocks of < 200 J simply were a waste of time.…”