Document Detail

Impact of electrical shock waveform and paddle positions on efficacy of direct current cardioversion for atrial fibrillation
MedLine Citation:
PMID:  18971603     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Direct-current electrical cardioversion is the main method for the conversion of atrial fibrillation. Its success depends on many factors. In several studies, biphasic shock waveforms have been demonstrated to be superior to monophasic shocks for termination of atrial fibrillation; however, information about impact of paddle position is controversial. Initial energy level is an object of discussions. The aim of the study was to compare a truncated exponential biphasic waveform with monophasic damped sine waveform and antero-lateral with antero-posterior paddle positions for cardioversion of atrial fibrillation, to determine its impact on early reinitiation of atrial fibrillation. MATERIAL AND METHODS: A total of 224 consecutive patients with atrial fibrillation underwent electrical cardioversion with biphasic (Bi, n=112) or monophasic (Mo, n=112) shock waveform in a randomized fashion. The position of hand-held paddle electrodes was randomly selected in both groups to be anterior-lateral and anterior-posterior. Energies used were 100-150-200-300-360 J (Bi) or 100-200-300-360 J (Mo). If monophasic shock of 360 J was ineffective, we used biphasic shock of 360 J. Early recurrent atrial fibrillation (ERAF) was defined as a relapse of atrial fibrillation within 2 min after a successful cardioversion, acute recurrent - within 24 h. RESULTS: Two study groups (Bi vs Mo) did not differ with regard to age, body mass index, duration of AF episode (mean 98+/-147 days for the Bi group and 80+/-93 days for the Mo group, P=0.26), underlying heart disease, left atrial diameter, left ventricular ejection fraction. In the Mo group, more patients used amiodarone (59.82% vs 41.97%, P=0.002), in the Bi group more patients used propafenone (16.07% vs 8.93%, P=0.033). Cardioversion success rate was 97.32% in the Bi group and 79.46% in the Mo group (P<0.001). After biphasic shock of 360 J in Mo group, the cumulative success rate was 99.11%. Mean delivered energy and mean number of shocks were significantly lower in the Bi group (198.5+/-204.4 J, 1.5+/-0.9 shocks vs 489.1+/-464.2 J, 2.4+/-1.5 shocks). The efficacy of first shock was 66.96% in the Bi group and 37.5% in the Mo group (P<0.0001). Incidence of ERAF was 4.46% in both groups. Paddle position had no impact on efficacy of cardioversion and ERAF. CONCLUSIONS: For the cardioversion of atrial fibrillation, biphasic shock waveform has a higher success rate than monophasic shock waveform. We did not observe the influence of paddle positions on efficacy of cardioversion. Shock waveform and paddle position had no impact on ERAF. We recommend starting with biphasic energy of 150 J and monophasic of not less than 200 J for cardioversion of atrial fibrillation.
Giedre Stanaitiene; Rūta Marija Babarskiene
Publication Detail:
Type:  Comparative Study; English Abstract; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Medicina (Kaunas, Lithuania)     Volume:  44     ISSN:  1648-9144     ISO Abbreviation:  Medicina (Kaunas)     Publication Date:  2008  
Date Detail:
Created Date:  2008-10-30     Completed Date:  2008-11-24     Revised Date:  2009-07-10    
Medline Journal Info:
Nlm Unique ID:  9425208     Medline TA:  Medicina (Kaunas)     Country:  Lithuania    
Other Details:
Languages:  lit     Pagination:  665-72     Citation Subset:  IM    
Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
Vernacular Title:
Elektros impulso formos ir elektrodu pozicijos itaka elektrinei kardioversijai nutraukiant priesirdziu virpejima.
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MeSH Terms
Amiodarone / therapeutic use
Anti-Arrhythmia Agents / therapeutic use
Atrial Fibrillation / drug therapy,  therapy*
Body Mass Index
Chi-Square Distribution
Data Interpretation, Statistical
Electric Countershock / methods*
Middle Aged
Propafenone / therapeutic use
Prospective Studies
Treatment Outcome
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 1951-25-3/Amiodarone; 54063-53-5/Propafenone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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