Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis
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...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/2/e002456.full |
| _version_ | 1797367213252935680 |
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| author | Gregory Y H Lip Nicklas Vinter Lars Frost Søren Paaske Johnsen Ludovic Trinquart Mikkel Zacharias Bystrup Holst-Hansen |
| author_facet | Gregory Y H Lip Nicklas Vinter Lars Frost Søren Paaske Johnsen Ludovic Trinquart Mikkel Zacharias Bystrup Holst-Hansen |
| author_sort | Gregory Y H Lip |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T17:14:05Z |
| format | Article |
| id | doaj.art-a125491a26e4469cae983ce760f53528 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-03-08T17:14:05Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-a125491a26e4469cae983ce760f535282024-01-03T17:25:07ZengBMJ Publishing GroupOpen Heart2053-36242023-11-0110210.1136/openhrt-2023-002456Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysisGregory Y H Lip0Nicklas Vinter1Lars Frost2Søren Paaske Johnsen3Ludovic Trinquart4Mikkel Zacharias Bystrup Holst-Hansen5Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UKDanish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkDiagnostic Centre, Silkeborg Regional Hospital, Silkeborg, DenmarkDanish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkDanish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkDiagnostic Centre, Silkeborg Regional Hospital, Silkeborg, DenmarkObjective 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.https://openheart.bmj.com/content/10/2/e002456.full |
| spellingShingle | Gregory Y H Lip Nicklas Vinter Lars Frost Søren Paaske Johnsen Ludovic Trinquart Mikkel Zacharias Bystrup Holst-Hansen Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis Open Heart |
| title | Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis |
| title_full | Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis |
| title_fullStr | Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis |
| title_full_unstemmed | Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis |
| title_short | Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis |
| title_sort | electrical energy by electrode placement for cardioversion of atrial fibrillation a systematic review and meta analysis |
| url | https://openheart.bmj.com/content/10/2/e002456.full |
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