Is Fluoroscopic Electrode Positioning Improving the Clinical Efficacy of External Biphasic Cardioversion in Patients with Atrial Fibrillation?
The use of external direct current (DC) transthoracic capacitor discharge to terminate atrial fibrillation (AF) was first reported in 1962 by Lown et al. . However, external DC cardioversion with a monophasic damped sine waveform in patients with AF is ineffective in 6%-50% of cases [2-4]. An alternative when conventional DC cardioversion fails is low-energy internal cardioversion, performance of which carries increased risk because of the catheter insertion . Recently, a biphasic shock waveform have been shown to be superior to monophasic shock in the treatment of AF patients. Mittal et al.  confirmed that rectilinear biphasic shock was more effective than monophasic shock for external atrial cardioversion in a prospective multicenter trial. The cumulative efficacy with the biphasic waveform was significantly greater than that with the monophasic waveform (94% vs 79%,p=0.005) .
The aim of the study was to compare the clinical efficacy of external cardioversion with rectilinear biphasic shock with fluoroscopy-guided electrode positioning versus standard electrode positioning (right anterior and left posterior) to increase the success rate of standard external cardioversion and avoiding the need of internal cardioversion in patients with AF.
KeywordsAtrial Fibrillation Atrial Fibrillation Patient Electrode Position Biphasic Waveform Internal Cardioversion
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Lown B, Amarasingham R, Neuman J (1962) New method for terminating cardiac arrhythmias-use of synchronised capacitor discharge. JAMA 182:548–555PubMedCrossRefGoogle Scholar
Ewy GA (1994) The optimal technique for electrical cardioversion of atrial fibrillation. Clin Cardiol 17:79–84PubMedCrossRefGoogle Scholar
Kerber RE, Jensen SR, Grayzel J et al (1981) Elective cardioversion: influence of paddle-electrode location and size on success rates and energy requirements. N Engl J Med 305:658–662PubMedCrossRefGoogle Scholar
Mathew TP, Moore A, McIntyre M et al (1999) Randomized comparison of electrode positions for cardioversion of atrial fibrillation. Heart 81:576–579PubMedGoogle Scholar
Schmieder S, Schneider M, Karch MR et al (2001) Internal low energy cardioversion of atrial fibrillation using a single lead system. Comparison of a left and right pulmonary artery catheter approach. Pacing Clin Electrophysiol 24:1108–1112PubMedCrossRefGoogle Scholar
Mittal S, Ayati S, Stein KM et al (2000) Transthoracic cardioversion of atrial fibrillation: comparison of rectilinear biphasic versus damped sine wave monophasic shocks. Circulation 101:1282–1287PubMedCrossRefGoogle Scholar
Ricard S, Levy S, Boccara G et al (2001) External cardioversion of atrial fibrillation: comparison of biphasic vs monophasic waveform shocks. Europace 3:96–99PubMedCrossRefGoogle Scholar
Capucci A, Villani GQ, Aschieri D et al (2000) Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J 21:66–73PubMedCrossRefGoogle Scholar
Oral H, Souza JJ, Michaud GF et al (1999) Facilitating transthoracic cardioversion of atrial fibrillation with ibutilide pretreatment. N Engl J Med 340:1849–1854PubMedCrossRefGoogle Scholar
Mehdirad AA, Clem KL, Love CJ et al (1999) Improved clinical efficacy of external cardioversion by fluoroscopic electrode positioning and comparison to internal cardioversion in patients with atrial fibrillation. Pacing Clin Electrophysiol 22(Part II):233–237PubMedCrossRefGoogle Scholar
© Springer-Verlag Italia 2003