期刊
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
卷 30, 期 2, 页码 155-161出版社
WILEY
DOI: 10.1111/jce.13786
关键词
atrial fibrillation; direct current cardioversion; left atrium; obesity; transthoracic impedance
资金
- Victorian Government's Operational Infrastructure Funding
- NHMRC/NHF postgraduate scholarships
- Baker IDI Bright Sparks scholarships
- NHMRC practitioner fellowship
AimsObesity is associated with higher electrical cardioversion (ECV) failure in persistent atrial fibrillation (PeAF). For ease-of-use, many centers prefer patches over paddles. We assessed the optimum modality and shock vector, as well as the safety and efficacy of the Manual Pressure Augmentation (MPA) technique. MethodsPatients with obesity (BMI30) and PeAF undergoing ECV using a biphasic defibrillator were randomized into one of four arms by modality (adhesive patches or handheld paddles) and shock vector (anteroposterior [AP] or anteroapical [AA]). If the first two shocks (100 and 200J) failed, then patients received a 200-J shock using the alternative modality (patch or paddle). Shock vector remained unchanged. In an observational substudy, 20 patients with BMI of 35 or more, and who failed ECV at 200J using both patches/paddles underwent a trial of MPA. ResultsIn total, 125 patients were randomized between July 2016 and March 2018. First or second shock success was 43 of 63 (68.2%) for patches and 56 of 62 (90.3%) for paddles (P=0.002). There were 20 crossovers from patches to paddles (12 of 20 third shock success with paddles) and six crossovers from paddles to patches (three of six third shock success with patches). Paddles successfully cardioverted 68 of 82 patients compared with 46 of 69 using patches (82.9% vs 66.7%; P=0.02). Shock vector did not influence first or second shock success rates (82.0% AP vs 76.6% AA; P=0.46). MPA was successful in 16 of 20 (80%) who failed in both (patches/paddles), with 360J required in six of seven cases. ConclusionRoutine use of adhesive patches at 200J is inadequate in obesity. Strategies that improve success include the use of paddles, MPA, and escalation to 360J.
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