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European Heart Journal Advance Access originally published online on April 11, 2005
European Heart Journal 2005 26(13):1298-1302; doi:10.1093/eurheartj/ehi196
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Impedance compensated biphasic waveforms for transthoracic cardioversion of atrial fibrillation: a multi-centre comparison of antero-apical and antero-posterior pad positions

Simon J. Walsh1, David McCarty1, Anthony J.J. McClelland1, Colum G. Owens1, Tom G. Trouton2, Mark T. Harbinson2, Siobhan O'Mullan2, Andrew McAllister3, Brian M. McClements3, Mike Stevenson4, Gavin W.N. Dalzell1 and A.A. Jennifer Adgey1,*

1Regional Medical Cardiology Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK
2Cardiology Department, Antrim Area Hospital, Bush Road, Antrim, Northern Ireland, UK
3Cardiology Department, Mater Infirmorum Hospital, Crumlin Road, Belfast, Northern Ireland, UK
4Department of Epidemiology and Public Health, Queen's University, University Road, Belfast, Northern Ireland, UK

Received 16 July 2004; revised 26 January 2005; accepted 3 February 2005; online publish-ahead-of-print 11 April 2005.

* Corresponding author. Tel: +44 28 90240503; fax: +44 28 90312907. E-mail address: jennifer.adgey{at}royalhospitals.n-i.nhs.uk

Aims To compare the success rate for transthoracic direct current cardioversion (DCC) of atrial fibrillation (AF) with antero-posterior (AP) and antero-apical (AA) electrode positions using an impedance compensated biphasic (ICB) waveform.

Methods and results Three-hundred and seven patients [mean age 66 (SD±13), 195 male] with AF were recruited in three centres. Patients were randomized to an AA (n=150) or AP (n=144) pad position. Thirteen patients with implanted pacemakers were defaulted to the AP pad position. Cardioversion was performed using an ICB waveform with a 70, 100, 150, and 200 J energy selection protocol. If the fourth shock was unsuccessful, the pads were crossed over to the alternative position for a final 200 J shock. Shock 1 was successful in 54/150 (36%) AA and 45/144 (31%) AP patients, whereas success was achieved by shock 2 in 99/150 (66%) AA and 74/144 (51%) AP, by shock 3 in 123/150 (82%) AA and 109/144 (76%) AP, and by shock 4 in 143/150 (95%) AA and 127/144 (88%) AP and after cross-over in 144/150 (96%) AA and 135/144 (94%) AP. Overall success rate was higher than expected at 95%. Pad position was not associated significantly with success. There was a trend towards an improved outcome with the AA configuration (P=0.05).

Conclusion The influence of pad position for DCC of AF may be less pertinent with ICB waveforms than with monophasic waveforms.

Key Words: Biphasic waveform • Atrial fibrillation • Direct current cardioversion • Pad position


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B M Glover, S J Walsh, C J McCann, M J Moore, G Manoharan, G W N Dalzell, A McAllister, B McClements, D J McEneaney, T G Trouton, et al.
Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial
Heart, July 1, 2008; 94(7): 884 - 887.
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