[Electrode position in elective electrical cardioversion of atrial fibrillation. A randomized study]

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia requiring electrical cardioversion (ECV).
• Optimizing electrode positioning is crucial for ECV success and minimizing energy delivery.

Purpose of the Study:

• To compare the efficacy of left anteroposterior (A-P) versus apex-anterior (A-A) electrode configurations for ECV in AF patients.
• To determine which electrode position achieves sinus rhythm with fewer shocks and lower energy requirements.

Main Methods:

• Randomized clinical trial involving ambulatory AF patients undergoing elective ECV.
• Biphasic shocks were administered sequentially with up to three shocks allowed per initial electrode position.
• Patients received treatment in an ICU setting of a second-level hospital.

Main Results:

• Sinus rhythm was restored in 92% of patients across both groups.
• The A-A position required significantly fewer shocks (1 vs. 2, p=0.003) and less energy (150 J vs. 350 J, p=0.017) compared to the A-P position.
• ECV failure in the A-A position was less likely to be converted by switching to A-P than vice versa (1/5 vs. 10/13, p=0.038).

Conclusions:

• The apex-anterior (A-A) electrode position demonstrates superior effectiveness for elective electrical cardioversion of atrial fibrillation.
• The A-A position is recommended as the preferred initial electrode configuration for AF cardioversion.