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European Heart Journal Advance Access published online on April 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi196
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received July 16, 2004
Revised January 26, 2005
Accepted February 3, 2005

Clinical research

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

Simon J. Walsh 1, David McCarty 1, Anthony J.J. McClelland 1, Colum G. Owens 1, Tom G. Trouton 2, Mark T. Harbinson 2, Siobhan O'Mullan 2, Andrew McAllister 3, Brian M. McClements 3, Mike Stevenson 4, Gavin W.N. Dalzell 1, and A. A. Jennifer Adgey 5*

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

* To whom correspondence should be addressed.
A. A. Jennifer Adgey, E-mail: jennifer.adgey{at}royalhospitals.n-i.nhs.uk


  Abstract

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.

Keywords: 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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