1
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Asad ZUA, Imran S, Parmar M, Bajwa A, Truong D, Agarwal S, Ghani A, Clifton S, Reese J, Khan MS, Munir MB, DeSimone CV, Sivaram C, Jackman WM, Po S, Stavrakis S, Al-Khatib SM. Antero-lateral vs. antero-posterior electrode position for cardioversion of atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2023; 66:1989-2001. [PMID: 36929367 DOI: 10.1007/s10840-023-01523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Multiple randomized controlled trials (RCTs) have compared the success of antero-lateral vs. antero-posterior electrode position for cardioversion of atrial fibrillation (AF). However, due to small sample size and conflicting results of these RCTs, the optimal electrode positioning for successful cardioversion remains uncertain. METHODS A systematic search of MEDLINE and EMBASE was conducted. Outcomes of interest included overall success of cardioversion with restoration of sinus rhythm, 1st shock success, 2nd shock success, mean shock energy required for successful cardioversion, mean number of shocks required for successful cardioversion, success of cardioversion at high energy (> 150 J) and success of cardioversion at low energy (< 150 J). Mantel-Haenszel risk ratios (RR) with 95% confidence intervals were calculated using random-effects model. RESULTS A total of 14 RCTs comprising 2445 patients were included. There was no statistically significant difference between two cardioversion approaches in the overall success of cardioversion (RR 1.02; 95% CI [0.97-1.06]; p = 0.43), first shock success (RR 1.14; 95% CI [0.99-1.32]), second shock success (RR 1.08; 95% CI [0.94-1.23]), mean shock energy required (mean difference 6.49; 95% CI [-17.33-30.31], success at high energy > 150 J (RR 1.02; 95% CI [0.92-1.14] and success at low energy < 150 J (RR 1.09; 95% CI [0.97-1.22]). CONCLUSIONS This meta-analysis of RCTs shows no significant difference in the success of cardioversion between antero-lateral vs. antero-posterior electrode position for cardioversion of AF. Large well-conducted and adequately powered randomized clinical trials are needed to definitively address this question.
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Affiliation(s)
- Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Sana Imran
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Miloni Parmar
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Awais Bajwa
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Derek Truong
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Asad Ghani
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shari Clifton
- Robert M Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jessica Reese
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, Oklahoma City, OK, USA
| | - Muhammad Shahzeb Khan
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | | | - Chittur Sivaram
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Warren M Jackman
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunny Po
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sana M Al-Khatib
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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2
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Vinter N, Holst-Hansen MZB, Johnsen SP, Lip GYH, Frost L, Trinquart L. Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis. Open Heart 2023; 10:e002456. [PMID: 37945283 PMCID: PMC10649887 DOI: 10.1136/openhrt-2023-002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Nicklas Vinter
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Lars Frost
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ludovic Trinquart
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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3
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Katzenschlager S, Elshaer A, Spoettl W. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med 2023; 388:861-863. [PMID: 36856632 DOI: 10.1056/nejmc2216382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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4
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Darrat Y, Leung S, Elayi L, Parrott K, Ogunbayo G, Kotter J, Sorrell V, Gupta V, Anaya P, Morales G, Catanzarro J, Delisle B, Elayi CS. A stepwise external cardioversion protocol for atrial fibrillation to maximize acute success rate. Europace 2023; 25:828-834. [PMID: 36748366 PMCID: PMC10062296 DOI: 10.1093/europace/euad009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/29/2022] [Indexed: 02/08/2023] Open
Abstract
AIMS Cardioversion is a very commonly performed procedure for persistent atrial fibrillation (AF). However, there is no well-defined protocol to address failed external electrical direct current cardioversion. The aim of the study is to test the efficacy of a pre-defined stepwise cardioversion protocol for patients with persistent AF of ≤12 months. Success was the achievement of sinus rhythm. METHODS AND RESULTS The study population included patients with persistent AF of ≤12 months duration requiring rhythm management. Patients were offered cardioversion using a pre-defined stepwise protocol using different electrode placement locations, applying compression at end of expiration, and higher energy delivered simultaneously through two defibrillators. : A total of 414 patients were included in the study, of which 362 (87.4%) required a single successful cardioversion. The remaining 52 (12.5%) patients required additional cardioversion attempts using the stepwise cardioversion protocol with an overall success rate of 99.3%. Two simultaneous defibrillators were required in 14 patients (3.4%). Patients with multiple cardioversions (13.5%) experienced more local skin irritation and pain compared with patients with single cardioversion (13.5% vs. 3.5%, P = 0.004). The predictor for the need for multiple cardioversion attempts is high body mass index, while high transthoracic impedance is associated with failed cardioversion. No major complications were observed during the study. CONCLUSION The stepwise cardioversion protocol has a high success rate of >99% and can be safely performed in outpatient or inpatient settings.
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Affiliation(s)
- Yousef Darrat
- Cardiac Electrophysiology Department, Saint Joseph Hospital, 1401 Harrodsburg Road, Lexington, KY 40504, USA
| | - Steve Leung
- Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Liliane Elayi
- Cardiac Electrophysiology Department, Saint Joseph Hospital, 1401 Harrodsburg Road, Lexington, KY 40504, USA
| | - Kevin Parrott
- Cardiac Electrophysiology Department, Baptist Health, Louisville, KY, USA
| | - Gbolahan Ogunbayo
- Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - John Kotter
- Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Vincent Sorrell
- Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Vedant Gupta
- Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Paul Anaya
- Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Gustavo Morales
- Cardiac Electrophysiology Department, Grandview Medical Center, Birmingham, AL, USA
| | - John Catanzarro
- Department of Internal Medicine, The University of Florida, Jacksonville, FL, USA
| | - Brian Delisle
- Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Claude S Elayi
- Cardiac Electrophysiology Department, Saint Joseph Hospital, 1401 Harrodsburg Road, Lexington, KY 40504, USA
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5
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Long B, Gottlieb M. Anterior-posterior versus anterior-lateral pad positioning for electrical cardioversion of atrial fibrillation. Acad Emerg Med 2023. [PMID: 36636927 DOI: 10.1111/acem.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
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6
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Nguyen ST, Belley-Côté EP, Ibrahim O, Um KJ, Lengyel A, Adli T, Qiu Y, Wong M, Sibilio S, Benz AP, Wolf A, Whitlock NJ, Gabriel Acosta J, Healey JS, Baranchuk A, McIntyre WF. Techniques improving electrical cardioversion success for patients with atrial fibrillation: a systematic review and meta-analysis. Europace 2022; 25:318-330. [PMID: 36503970 PMCID: PMC9935008 DOI: 10.1093/europace/euac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Electrical cardioversion is commonly used to restore sinus rhythm in patients with atrial fibrillation (AF), but procedural technique and clinical success vary. We sought to identify techniques associated with electrical cardioversion success for AF patients. METHODS AND RESULTS We searched MEDLINE, EMBASE, CENTRAL, and the grey literature from inception to October 2022. We abstracted data on initial and cumulative cardioversion success. We pooled data using random-effects models. From 15 207 citations, we identified 45 randomized trials and 16 observational studies. In randomized trials, biphasic when compared with monophasic waveforms resulted in higher rates of initial [16 trials, risk ratio (RR) 1.71, 95% CI 1.29-2.28] and cumulative success (18 trials, RR 1.10, 95% CI 1.04-1.16). Fixed, high-energy (≥200 J) shocks when compared with escalating energy resulted in a higher rate of initial success (four trials, RR 1.62, 95% CI 1.33-1.98). Manual pressure when compared with no pressure resulted in higher rates of initial (two trials, RR 2.19, 95% CI 1.21-3.95) and cumulative success (two trials, RR 1.19, 95% CI 1.06-1.34). Cardioversion success did not differ significantly for other interventions, including: antero-apical/lateral vs. antero-posterior positioned pads (initial: 11 trials, RR 1.16, 95% CI 0.97-1.39; cumulative: 14 trials, RR 1.01, 95% CI 0.96-1.06); rectilinear/pulsed biphasic vs. biphasic truncated exponential waveform (initial: four trials, RR 1.11, 95% CI 0.91-1.34; cumulative: four trials, RR 0.98, 95% CI 0.89-1.08) and cathodal vs. anodal configuration (cumulative: two trials, RR 0.99, 95% CI 0.92-1.07). CONCLUSIONS Biphasic waveforms, high-energy shocks, and manual pressure increase the success of electrical cardioversion for AF. Other interventions, especially pad positioning, require further study.
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Affiliation(s)
- Stephanie T Nguyen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada,Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Emilie P Belley-Côté
- Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada,Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada
| | - Omar Ibrahim
- Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Kevin J Um
- Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Alexandra Lengyel
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Taranah Adli
- Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5C1, Canada
| | - Yuan Qiu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada,University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Michael Wong
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Serena Sibilio
- Istituto Clinico Sant’Ambrogio, Università di Milano, Milano 20157, Italy
| | - Alexander P Benz
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University, Mainz 55131, Germany
| | - Alex Wolf
- University of Limerick School of Medicine, Limerick V94 T9PX, Ireland
| | - Nicola J Whitlock
- Bishop Tonnos Catholic Secondary School, Ancaster, Ontario L9G 5E3, Canada
| | - Juan Gabriel Acosta
- Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Jeff S Healey
- Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada,Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada
| | - Adrian Baranchuk
- Queen’s University School of Medicine, Queen’s University, Kingston, Ontario K7L 3L4, Canada
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7
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Eid M, Abu Jazar D, Medhekar A, Khalife W, Javaid A, Ahsan C, Shabarek N, Saad M, Rao M, Ong K, Jneid H, Elbadawi A. Anterior-Posterior versus anterior-lateral electrodes position for electrical cardioversion of atrial fibrillation: A meta-analysis of randomized controlled trials. IJC HEART & VASCULATURE 2022; 43:101129. [PMID: 36304256 PMCID: PMC9593304 DOI: 10.1016/j.ijcha.2022.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/15/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Background The optimal electrodes position for elective direct current (DC) cardioversion of patients with atrial fibrillation (AF) remains uncertain. Methods An electronic search of MEDLINE, EMBASE and COCHRANE databases was performed through March 2022 for randomized trials that examined the outcomes of anterior-posterior (AP) versus anterior-lateral (AL) electrodes position during cardioversion of (AF). The main outcome was the success rate of cardioversion. Data were pooled using random effects model. Results The final analysis included 10 RCTs with a total of 1677 patients. There was no difference in the rate of successful cardioversion between the AP versus AL groups (86.6 vs 87.9 %; RR 1.00; 95 % Confidence Interval (CI) 0.95 to 1.06). Subgroup analysis by the shock waveform showed no significant interaction between monophasic and biphasic waveforms (Pintercation = 0.23). meta-regression analyses showed no effect modification of primary outcome according to body mass index (p = 0.15), left atrial diameter (p = 0.64), valvular heart disease (p = 0.34), lone AF (p = 0.58), or the duration of AF (p = 0.70). There was no significant difference between the AP and AL electrode position groups in successful cardioversion at low energy (RR 0.94; 95 % CI 0.74 to 1.19), the number of the delivered shocks (standardized mean difference [SMD] −0.03; 95 % CI −0.32 to 0.26) or the mean energy of the delivered shocks (SMD −0.11 and 95 % CI −0.30 to 0.07). There was lower transthoracic impedance with AP versus AL electrode position (SMD −0.28; 95 %CI −0.47 to −0.10). Conclusion Meta-analysis of randomized data showed no difference between AP and AL electrode positions in the success rate of DC cardioversion of AF. Either AP or AL electrode positions should be acceptable approaches for elective DC cardioversion of patients with AF.
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Affiliation(s)
- Mennaallah Eid
- Department of Internal Medicine, Lincoln Medical Center, New York, NY, United States
| | - Deaa Abu Jazar
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Ankit Medhekar
- Section of Cardiology, Baylor College of Medicine, Houston, TX, United States
| | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, United States
| | - Awad Javaid
- Department of Cardiology-University of Nevada, Las Vegas-Kirk Kirkorian School of Medicine, USA
| | - Chowdhury Ahsan
- Department of Cardiology-University of Nevada, Las Vegas-Kirk Kirkorian School of Medicine, USA
| | - Nehad Shabarek
- Department of Internal Medicine, Lincoln Medical Center, New York, NY, United States
| | - Marwan Saad
- Division of interventional structural Heart Research, Lifespan Cardiovascular Institute Interventional Cardiology and Structural Heart Disease, Rhode Island, NY, United States
| | - Mohan Rao
- Division of Cardiology, Rochester General Hospital, Rochester, NY, United States
| | - Kenneth Ong
- Division of Cardiology, Lincoln Medical Center, New York, NY, United States
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, TX, United States
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States,Corresponding author at: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, United States.
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8
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Massaro G, Spagni S, Martignani C, Bettazzoni L, Spadotto A, Ziacchi M, Biffi M, Galiè N, Boriani G, Frisoni J, Diemberger I. Personalizing configuration for atrial fibrillation external electrical cardioversion to improve first shock efficacy. J Cardiovasc Med (Hagerstown) 2022; 23:655-662. [PMID: 36099072 DOI: 10.2459/jcm.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite the common use of biphasic electrical cardioversion (ECV) to convert atrial fibrillation (AF), we lack definite recommendations on electrode configuration. METHODS We adopted a quasi-experimental design enrolling all candidates to ECV for AF. In the first stage, two units were involved, one using antero-apical pads (AAP) and the second antero-posterior adhesive patches (APP). These data enabled the creation of a decision algorithm to personalize the ECV approach, which was subsequently validated during the second stage. RESULTS A total of 492 patients were enrolled overall. In the first stage, APP and AAP presented similar conversion rates (87.4 vs. 86.9% at first attempt of a step-up protocol, P = 0.661). While body surface area (BSA) ≤2.12 m2 was an independent predictor in the overall population, the two components (height and weight) acted differently in the two configurations: being height ≤1.73 m2 a significant cut-off value in the AAP subgroup, and weight <83 kg in the APP subgroup. Considering these cut-offs, we developed a decision algorithm for electrode configuration. In the second stage, algorithm validation confirmed an improvement in the first shock efficacy with respect to the results of the first stage (93.2 vs. 87.2%, P = 0.025), with a significant reduction in shock impedance (70.8 ± 15.3 vs. 81.8 ± 15.6, P < 0.001). CONCLUSION Patients with high BSA require high energy shocks for sinus rhythm restoration with ECV. Weight seems to affect more APP configuration, while height seems to impact more for the AAP. These findings have the potential to optimize ECV in clinical practice.
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Affiliation(s)
- Giulia Massaro
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Stefano Spagni
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Cristian Martignani
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Luca Bettazzoni
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Alberto Spadotto
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Matteo Ziacchi
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Mauro Biffi
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Giuseppe Boriani
- Cardiology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Frisoni
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
| | - Igor Diemberger
- Cardiology Unit, Cardio-Thoracic-Vascular Building, S.Orsola-Malpighi Policlinic, University of Bologna, Bologna
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9
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Einfach und praktisch: Elektrische Kardioversion. Notf Rett Med 2022. [DOI: 10.1007/s10049-021-00843-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Abstract
Rate and rhythm control are still considered equivalent strategies for symptom control using the Atrial Fibrillation Better Care algorithm recommended by the recent atrial fibrillation guideline. In acute situations or critically ill patients, a personalized approach should be used for rapid rhythm or rate control. Even though electrical cardioversion is generally indicated in haemodynamically unstable patients or for rapid effective rhythm control in critically ill patients, this is not always possible due to the high percentage of failure or relapses in such patients. Rate control remains the background therapy for all these patients, and often rapid rate control is mandatory. Short and rapid-onset-acting beta-blockers are the most suitable drugs for acute rate control. Esmolol was the classical example; however, landiolol a newer very selective beta-blocker, recently included in the European atrial fibrillation guideline, has a more favourable pharmacokinetic and pharmacodynamic profile with less haemodynamic interference and is better appropriate for critically ill patients.
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11
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Schmidt AS, Lauridsen KG, Møller DS, Christensen PD, Dodt KK, Rickers H, Løfgren B, Albertsen AE. Anterior-Lateral Versus Anterior-Posterior Electrode Position for Cardioverting Atrial Fibrillation. Circulation 2021; 144:1995-2003. [PMID: 34814700 DOI: 10.1161/circulationaha.121.056301] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Smaller randomized studies have reported conflicting results regarding the optimal electrode position for cardioverting atrial fibrillation. However, anterior-posterior electrode positioning is widely used as a standard and believed to be superior to anterior-lateral electrode positioning. Therefore, we aimed to compare anterior-lateral and anterior-posterior electrode positioning for cardioverting atrial fibrillation in a multicenter randomized trial. METHODS In this multicenter, investigator-initiated, open-label trial, we randomly assigned patients with atrial fibrillation scheduled for elective cardioversion to either anterior-lateral or anterior-posterior electrode positioning. The primary outcome was the proportion of patients in sinus rhythm after the first shock. The secondary outcome was the proportion of patients in sinus rhythm after up to 4 shocks escalating to maximum energy. Safety outcomes were any cases of arrhythmia during or after cardioversion, skin redness, and patient-reported periprocedural pain. RESULTS We randomized 468 patients. The primary outcome occurred in 126 patients (54%) assigned to the anterior-lateral electrode position and in 77 patients (33%) assigned to the anterior-posterior electrode position (risk difference, 22 percentage points [95% CI, 13-30]; P<0.001). The number of patients in sinus rhythm after the final cardioversion shock was 216 (93%) assigned to anterior-lateral electrode positioning and 200 (85%) assigned to anterior-posterior electrode positioning (risk difference, 7 percentage points [95% CI, 2-12]). There were no significant differences between groups in any safety outcomes. CONCLUSIONS Anterior-lateral electrode positioning was more effective than anterior-posterior electrode positioning for biphasic cardioversion of atrial fibrillation. There were no significant differences in any safety outcome. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03817372.
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Affiliation(s)
- Anders Sjørslev Schmidt
- Department of Internal Medicine, Randers Regional Hospital, Denmark (A.S.S., K.G.L., H.R., B.L.).,Research Center for Emergency Medicine, Aarhus University Hospital, Denmark (A.S.S., K.G.L., B.L.)
| | - Kasper Glerup Lauridsen
- Department of Internal Medicine, Randers Regional Hospital, Denmark (A.S.S., K.G.L., H.R., B.L.).,Research Center for Emergency Medicine, Aarhus University Hospital, Denmark (A.S.S., K.G.L., B.L.)
| | | | - Per Dahl Christensen
- Department of Cardiology, Viborg Regional Hospital, Denmark (D.S.M., P.D.C., A.E.A.)
| | - Karen Kaae Dodt
- Department of Internal Medicine, Horsens Regional Hospital, Denmark (K.K.D.)
| | - Hans Rickers
- Department of Internal Medicine, Randers Regional Hospital, Denmark (A.S.S., K.G.L., H.R., B.L.)
| | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Denmark (A.S.S., K.G.L., H.R., B.L.).,Research Center for Emergency Medicine, Aarhus University Hospital, Denmark (A.S.S., K.G.L., B.L.).,Department of Clinical Medicine, Aarhus University (B.L.)
| | - Andi Eie Albertsen
- Department of Cardiology, Viborg Regional Hospital, Denmark (D.S.M., P.D.C., A.E.A.)
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12
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Paré D, L'Écuyer JB, Mercier É. Association Between Pad Placement and the Return of Spontaneous Circulation for Defibrillation During Ventricular Fibrillation: A Systematic Review. J Innov Card Rhythm Manag 2021; 12:4533-4535. [PMID: 34234986 PMCID: PMC8225305 DOI: 10.19102/icrm.2021.120607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/08/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- David Paré
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Julien Blais L'Écuyer
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Éric Mercier
- VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
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13
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Little K, Klein D. Most Effective Pad Placement in Elective Cardioversion. Crit Care Nurse 2021; 40:79-82. [PMID: 32737500 DOI: 10.4037/ccn2020402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Kayla Little
- Kayla Little is a clinical nurse specialist in the cardioivascular medicine stepdown units, Cleveland Clinic, Cleveland, Ohio
| | - Deborah Klein
- Deborah Klein is a clinical nurse specialist in the coronary and heart failure intensive care units, and in the cardiac short stay, postanesthesia care, and cardiac accelerated care units, Cleveland Clinic
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14
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. [Adult advanced life support]. Notf Rett Med 2021; 24:406-446. [PMID: 34121923 PMCID: PMC8185697 DOI: 10.1007/s10049-021-00893-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Advanced Life Support guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Köln, Köln, Deutschland
| | - Pierre Carli
- SAMU de Paris, Center Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, Frankreich
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
- Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Charles D. Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, Großbritannien
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Großbritannien
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Schweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Schweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italien
| | - Gavin D. Perkins
- Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, Großbritannien
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rom, Italien
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rom, Italien
| | - Jerry P. Nolan
- Warwick Medical School, Coventry, Großbritannien, Consultant in Anaesthesia and Intensive Care Medicine Royal United Hospital, University of Warwick, Bath, Großbritannien
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15
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Abstract
Bradyarrhythmias represent a common pathology in the intensive care unit (ICU) with etiologies of varying severity. Treatment has often been focused on correcting underlying causes and may require pacing for urgent hemodynamic support. In recent years, there has been interest in physiologic pacing modalities which avoid the dyssynchrony from right ventricular (RV) only pacing. Cardiac resynchronization therapy (CRT) through biventricular pacing is a well-established device-based electrical therapy in patients with wide QRS and heart failure. Recently, it has been shown that biventricular pacing may also be pursued for hemodynamic rescue in the ICU setting. Efforts to re-engage the conduction system with His bundle pacing or further downstream have also emerged as alternative means to deliver resynchronization, with early applications in the ICU now being reported. The goal of the review is to examine bradyarrhythmia causes and management in the ICU as well as investigate new approaches in physiologic pacing and their potential roles in critically ill patients.
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Affiliation(s)
- Jonathan Lattell
- Center for Arrhythmia Care
- Heart and Vascular Institute, University of Chicago Pritzker School of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care
- Heart and Vascular Institute, University of Chicago Pritzker School of Medicine, The University of Chicago Medicine, Chicago, IL, USA
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17
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161:115-151. [PMID: 33773825 DOI: 10.1016/j.resuscitation.2021.02.010] [Citation(s) in RCA: 479] [Impact Index Per Article: 159.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Pierre Carli
- SAMU de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry,UK
| | - Charles D Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne,UK
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden, Department of Medicine Solna, Karolinska Institutet,Stockholm, Sweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet Mainz, Germany
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Italy
| | - Gavin D Perkins
- University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL; Royal United Hospital, Bath, UK
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18
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5461] [Impact Index Per Article: 1820.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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19
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Velázquez-Rodríguez E, Pérez-Sandoval HA, Rangel-Rojo FJ. Orthogonal electrical cardioversion in atrial fibrillation refractory to biphasic shocks: a case series. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33442616 PMCID: PMC7793132 DOI: 10.1093/ehjcr/ytaa343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/12/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022]
Abstract
Background Biphasic waveform shock has been established as the standard method for cardioversion of atrial fibrillation (AF). Depending on various factors, standard electrical cardioversion for AF may be unsuccessful in some cases, even with biphasic shocks. Case summary We report the safety and efficacy of orthogonal electrical cardioversion (OECV) as an alternative in patients with paroxysmal AF refractory to standard biphasic electrical cardioversion after up to three subsequent shocks of increasing energy and/or two or three initial shocks with maximum energy of 200-Joules. Shocks were delivered with two external defibrillators via two sets of adhesive electrode pads to apply two perpendicular electrical vectors in a simultaneous-sequential mode in antero-lateral and antero-posterior configuration. Five patients, mean age 54.4 ± 11, three with hypertensive heart disease and a body mass index 27.2 ± 2 kg/m2. All individual mean impedance before OECV was 79 ± 5 Ω with a mean peak current applied of 22 ± 4.5 A. Restoration of sinus rhythm with OECV was achieved acutely and sustained in all five patients. No patients developed haemodynamic instability or thromboembolic events. Discussion Double simultaneous shocks in an orthogonal configuration could theoretically decrease the defibrillation threshold through the ability of sequential pulses applying a more efficient and uniform current density. OECV using lower/medium energy may be another useful rescue strategy in AF refractory to standard biphasic shocks.
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Affiliation(s)
- Enrique Velázquez-Rodríguez
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Subdirección de Servicios de Salud, Hospital Central Norte, Pemex, Universidad Nacional Autónoma de México, Campo Matillas 52, Col. San Antonio, 02720 Ciudad de México, Mexico
| | - Hipólito Alfredo Pérez-Sandoval
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Subdirección de Servicios de Salud, Hospital Central Norte, Pemex, Universidad Nacional Autónoma de México, Campo Matillas 52, Col. San Antonio, 02720 Ciudad de México, Mexico
| | - Francisco Javier Rangel-Rojo
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Subdirección de Servicios de Salud, Hospital Central Norte, Pemex, Universidad Nacional Autónoma de México, Campo Matillas 52, Col. San Antonio, 02720 Ciudad de México, Mexico
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20
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Young ML, Exelbert EJ, Roth T, Cohen L, Cogan J. External Cardioversion-Defibrillation with Pushing Down on the Chest Wall to Increase the Success Rate in Obese Patients. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927009. [PMID: 33196633 PMCID: PMC7680710 DOI: 10.12659/ajcr.927009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Case series Patients: Female, 17-year-old • Male, 63-year-old • Male, 65-year-old Final Diagnosis: Atrial fibrillation Symptoms: Palpitations Medication: — Clinical Procedure: Cardioversion Specialty: Cardiology • Pediatrics and Neonatology
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Affiliation(s)
- Ming-Lon Young
- Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Eric J Exelbert
- Pediatric Intensive Care Unit, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Todd Roth
- Memorial Cardiac and Vascular Institute, Memorial Regional Hospital, Memorial HealthCare System, Hollywood, FL, USA
| | - Lance Cohen
- Cardiovascular Intensive Care Unit (ICU), Memorial Cardiac and Vascular Institute, Memorial Regional Hospital, Memorial HealthCare System, Hollywood, FL, USA
| | - John Cogan
- Memorial Cardiac and Vascular Institute, Memorial Regional Hospital, Memorial HealthCare System, Hollywood, FL, USA
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21
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Andrade JG, Aguilar M, Atzema C, Bell A, Cairns JA, Cheung CC, Cox JL, Dorian P, Gladstone DJ, Healey JS, Khairy P, Leblanc K, McMurtry MS, Mitchell LB, Nair GM, Nattel S, Parkash R, Pilote L, Sandhu RK, Sarrazin JF, Sharma M, Skanes AC, Talajic M, Tsang TSM, Verma A, Verma S, Whitlock R, Wyse DG, Macle L. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation. Can J Cardiol 2020; 36:1847-1948. [PMID: 33191198 DOI: 10.1016/j.cjca.2020.09.001] [Citation(s) in RCA: 319] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia, Vancouver, British Columbia, Canada; Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Martin Aguilar
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Alan Bell
- University of Toronto, Toronto, Ontario, Canada
| | - John A Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jafna L Cox
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Dorian
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Paul Khairy
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Girish M Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stanley Nattel
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Jean-François Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Mukul Sharma
- McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Mario Talajic
- Montreal Heart Institute, University of Montreal, Montréal, Quebec, Canada
| | - Teresa S M Tsang
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Laurent Macle
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
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22
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Potapova KV, Nosov VP, Koroleva LY, Amineva NV. [Atrial Flutter: up-to-date Problem Evaluation with Clinical Positions]. ACTA ACUST UNITED AC 2020; 60:70-80. [PMID: 32245357 DOI: 10.18087/cardio.2020.1.n693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
Abstract
The review provides current ideas about the etiology and prevalence of atrial flutter (AF), mechanism and substrate of arrhythmogenesis, and principles of clinical and electrophysiological classification of this arrhythmia. Methods for conservative and surgical treatments of AF, including their comparative aspect, are described in detail. The review presented recent data on efficacy and potential risks of different approaches to reversing the arrhythmia. The authors indicated a need for early diagnosis and strict control of the sinus rhythm in AF, which would help a successful intervention not only to completely cure the existing arrhythmia but also to prevent other heart rhythm disorders, primarily atrial fibrillation.
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Affiliation(s)
| | - V P Nosov
- Privolzhsky Research Medical University
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23
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Schmidt AS, Lauridsen KG, Løfgren B. Maximizing cardioversion efficacy: maximum-fixed energy shocks and what else? Eur Heart J 2019; 41:722. [DOI: 10.1093/eurheartj/ehz797] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anders S Schmidt
- Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, 8200 Aarhus N, Denmark
| | - Kasper G Lauridsen
- Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, 8200 Aarhus N, Denmark
| | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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24
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Abstract
The prevalence of atrial fibrillation is increasing rapidly, resulting in more patients presenting for care in the emergency department and in-hospital settings. To reduce morbidity and mortality, and improve patient quality of life, clinicians working in these settings need to be both current and facile in their approach to management of these patients. Frequent updates to guideline recommendations (based on emerging research) make this challenging for practicing physicians. This article reviews the acute management of atrial fibrillation in the emergency and in-hospital settings, including practical approaches to rhythm and rate control, anticoagulation, and special situations, incorporating the most up-to-date guidelines.
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Affiliation(s)
- Clare L Atzema
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G146, Toronto, ON M4N 3M5, Canada.
| | - Sheldon M Singh
- Division of Cardiology, Department of Medicine, University of Toronto, Schulich Heart Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, A222, Toronto, ON M4N 3M5, Canada
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25
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 926] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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27
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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28
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Affiliation(s)
- Clare L Atzema
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Tyler W Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
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29
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Lawton LD. Cardioversion. Emerg Med Australas 2014; 26:627-9. [PMID: 25440535 DOI: 10.1111/1742-6723.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Luke D Lawton
- Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia
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