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European Heart Journal Advance Access originally published online on February 25, 2005
European Heart Journal 2005 26(13):1292-1297; doi:10.1093/eurheartj/ehi160
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

A trial of self-adhesive patch electrodes and hand-held paddle electrodes for external cardioversion of atrial fibrillation (MOBIPAPA)

Paulus Kirchhof1,3,*, Gerold Mönnig1, Kristina Wasmer1, Achim Heinecke2, Günter Breithardt1,3, Lars Eckardt1 and Dirk Böcker1

1Department of Cardiology and Angiology, Universitätsklinikum Münster, Albert-Schweitzer-Straße 33, D-48149 Münster, Germany
2Coordinating Centre for Clinical Trials, Hospital of the University of Münster, Münster, Germany
3Kompetenznetz Vorhofflimmern (AFNET)

Received 30 July 2004; revised 23 December 2004; accepted 6 January 2005; online publish-ahead-of-print 25 February 2005.

* Corresponding author. Tel: +49 251 8345160; fax: +49 251 8347864. E-mail address: kirchhp{at}uni-muenster.de

Aims External electrical cardioversion is the method of choice to terminate persistent atrial fibrillation. Whether the type of shock electrode affects cardioversion success is not known. We tested whether hand-held steel electrodes improve cardioversion outcome with monophasic or biphasic shocks when compared with adhesive patch electrodes.

Methods and results Two hundred and one consecutive patients with persistent atrial fibrillation (147 male, mean age 63±1 years, duration of atrial fibrillation 6.3±1 months) were randomly assigned to cardioversion using either a sinusoidal monophasic or a truncated exponential biphasic shock wave form. The first half of patients were cardioverted using adhesive patch electrodes, the second half using hand-held steel paddle electrodes, and all patients using an anterior–posterior electrode position. Paddle electrodes successfully cardioverted 100/104 patients (96%) and patch electrodes 85/97 patients (88%, P=0.04). This effect was comparable to that of biphasic shocks: biphasic shocks cardioverted 102/104 patients (98%) and monophasic shocks 83/97 patients (86%, P=0.001). A beneficial effect of paddle electrodes was observed for both shock wave forms. After cross-over from an ineffective monophasic to a biphasic shock, cardioversion was successful in 198/201 (98.5%) patients. Unsuccessful cardioversion after cross-over (3/201 patients) only occurred with patch electrodes (P=0.07).

Conclusion Hand-held paddle electrodes increase success of external cardioversion of atrial fibrillation in this trial. This increase is of similar magnitude as the increase in cardioversion success achieved with biphasic shocks. A combination of biphasic shocks, paddle electrodes, and an anterior–posterior electrode position renders outcome of external cardioversion almost always successful (104/104 patients in this trial).

Key Words: Cardioversion • Persistent atrial fibrillation • Shock electrode type • Controlled clinical trial • Rhythm control


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