Techniques improving electrical cardioversion success for patients with atrial fibrillation: a systematic review and meta-analysis.

Autor:	Nguyen ST; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.; Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada., Belley-Côté EP; Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.; Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada., Ibrahim O; Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada., Um KJ; Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada., Lengyel A; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada., Adli T; Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5C1, Canada., Qiu Y; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.; University of Ottawa, Ottawa, Ontario K1N 6N5, Canada., Wong M; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada., Sibilio S; Istituto Clinico Sant'Ambrogio, Università di Milano, Milano 20157, Italy., Benz AP; Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University, Mainz 55131, Germany., Wolf A; University of Limerick School of Medicine, Limerick V94 T9PX, Ireland., Whitlock NJ; Bishop Tonnos Catholic Secondary School, Ancaster, Ontario L9G 5E3, Canada., Gabriel Acosta J; Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada., Healey JS; Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.; Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada., Baranchuk A; Queen's University School of Medicine, Queen's University, Kingston, Ontario K7L 3L4, Canada., McIntyre WF; Department of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.; Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2023 Feb 16; Vol. 25 (2), pp. 318-330.
DOI:	10.1093/europace/euac199
Abstrakt:	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. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu