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. 1999 Jun;81(6):576–579. doi: 10.1136/hrt.81.6.576

Randomised comparison of electrode positions for cardioversion of atrial fibrillation

T Mathew 1, A Moore 1, M McIntyre 1, M Harbinson 1, N Campbell 1, A Adgey 1, G Dalzell 1
PMCID: PMC1729050  PMID: 10336913

Abstract

OBJECTIVE—To compare the relative efficacy of anteroanterior v anteroposterior electrode pad positions for external cardioversion of atrial fibrillation.
DESIGN—Prospective randomised trial.
SETTING—Tertiary referral cardiology centre in the United Kingdom.
PATIENTS—90 patients undergoing elective cardioversion for atrial fibrillation.
INTERVENTIONS—Cardioversion was attempted with self adhesive electrode pads with an area of 106 cm2 placed either in the anteroanterior (AA) or anteroposterior (AP) positions. Initial shock was 100 J which, if unsuccessful, was followed by 200 J, 300 J, and 360 J if required. Peak current and transthoracic impedance were measured.
MAIN OUTCOME MEASURES—Cardioversion success rate and energy requirements.
RESULTS—Cardioversion was successful in 81% of the patients (73/90). There was no statistically significant difference in the cardioversion success rate (AA 84%, 38/45 patients; AP 78%, 35/45 patients; p = 0.42) or mean (SD) energy requirement for all patients (AA 223 (96.1) J; AP 232 (110) J) or for patients who were successfully cardioverted (AA 197.9 (82.4) J; AP 195.4 (97.2) J; p = 0.9) between the two pad positions. The mean transthoracic impedance (TTI) for the first shock (AA 77.5 (18.4) ohms; AP 73.7 (18.7) ohms; p = 0.34) was not significantly different between the two groups. TTI correlated significantly with body mass index, percentage body fat, and chest AP diameter. There was a progressive decrease in TTI with serial shocks. While aetiology and TTI were the two independent significant predictive factors for energy requirement, duration of atrial fibrillation was the only independent predictor of cardioversion success in a multivariate analysis.
CONCLUSIONS—Electrode pad position is not a determinant of cardioversion success rate or energy requirement.


Keywords: atrial fibrillation; cardioversion; electrode pad position

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Figure 1  .

Figure 1  

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Cumulative cardioversion success rate at each energy level according to pad position. AA, anteroanterior; AP, anteroposterior.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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