TITLE

Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial

AUTHOR(S)
Glover, B. M.; Walsh, S. J.; Mccann, C. J.; Moore, M. J.; Manoharan, G.; Dalzell, G. W. N.; McAllister, A.; McClements, B.; McEneaney, D. J.; Trouton, T. G.; Mathew, T. P.; Adgey, A. A. J.
PUB. DATE
July 2008
SOURCE
Heart;Jul2008, Vol. 94 Issue 7, p884
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Aims: To compare the efficacy and safety of an escalating energy protocol with a non-escalating energy protocol using an impedance compensated biphasic defibrillator for direct current cardioversion of atrial fibrillation (AF). Methods and results: This prospective multicentre randomised trial enrolled 380 patients (248 male, mean (SD) age 67(10) years) with AF. Patients were randomised to either an escalating energy protocol (protocol A: 100 J, 150 J, 200 J, 200 J), or a non-escalating energy protocol (protocol B: 200 J, 200 J, 200 J). Cardioversion was performed using an impedance compensated biphasic waveform. First-shock success was significantly higher for those randomised to 200 J than 100 J (71% vs 48%; p<0.01) and for patients with a body mass index (BMI) >25 kg/m² (75% vs 44%; p = 0.01). In patients with a normal BMI there was no significant difference in first-shock success. There was also no significant difference between subsequent shocks or overall success. The use of a non-escalating protocol (protocol B) resulted in fewer shocks but with a higher cumulative energy. There was no difference in duration of procedure, amount of sedation administered or post- shock erythema between the groups. Conclusion: First-shock success was significantly higher, particularly in patients with a BMI >25 kg/m², when a non-escalating initial 200 J energy was selected. The overall success, duration of procedure and amount of sedation administered, however, did not differ significantly between the two protocols.
ACCESSION #
32900179

 

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