Vinter, Nicklas 
ORCID: 0000-0003-0558-8483, Holst-Hansen, Mikkel Zacharias Bystrup, Johnsen, Søren Paaske ORCID: 0000-0002-2787-0271, Lip, Gregory YH ORCID: 0000-0002-7566-1626, Frost, Lars ORCID: 0000-0001-9215-9796 and Trinquart, Ludovic ORCID: 0000-0002-3028-4900
(2023)
Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis.
Open heart, 10 (2).
e002456-.
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Abstract
<h4>Objective</h4>Electrode patch position may not be critical for success when cardioverting atrial fibrillation (AF), but the relevance of applied electrical energy is unclarified. Our objective was to perform a meta-analysis of randomised trials to examine the dose-response relation between energy level and cardioversion success by electrode position in elective cardioversion.<h4>Methods</h4>We searched PubMed, Embase, The Cochrane Library, Google Scholar and Scopus Citations. Inclusion criteria were randomised controlled trials using biphasic shock waves and self-adhesive patches, and publication date from 2000 to 2023. We used random-effects dose-response models to meta-analyse the relation between energy level and cardioversion success by anterolateral and anteroposterior position. Random-effects models estimated pooled risk ratios (RR) for cardioversion success after the first and the final shocks between the two electrode positions.<h4>Results</h4>We included five randomised controlled trials (N=1078). After the first low-energy shock, the electrode position was not significantly associated with the likelihood of successful cardioversion (pooled RR anterolateral vs anteroposterior placement 1.28, 95% CI 0.93 to 1.76, with considerable heterogeneity). After a high-energy final shock, there was no evidence of an association between the electrode position and the cumulative chance of cardioversion success (pooled RR anterolateral vs anteroposterior 1.05, 95% CI 0.97 to 1.14). Regardless of electrode position, cardioversion success was significantly less likely with shock energy levels < 200J compared with 200J.<h4>Conclusion</h4>Evidence from contemporary randomised trials suggests that higher level of electrical energy is associated with higher conversion rate when cardioverting AF with a biphasic shockwave. Positioning of electrodes can be based on convenience.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Atrial Fibrillation, Electric Countershock, Electrodes |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 13 Dec 2023 11:36 |
| Last Modified: | 13 Dec 2023 11:36 |
| DOI: | 10.1136/openhrt-2023-002456 |
| Open Access URL: | https://doi.org/10.1136/openhrt-2023-002456 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3177332 |
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