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Investigating the efficacy of chest pressure for direct current cardioversion in atrial fibrillation: a randomised
David Ferreira1,2, Philo Mikhail3, Michael McGee2,4
1Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia david.ferreira@health.nsw.gov.au.
Insights
Routine chest pressure during direct current cardioversion for atrial fibrillation (AF) may improve success rates. This randomized trial investigates if applying chest pressure from the first shock enhances cardioversion efficacy and safety in AF patients.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Trials
Background:
- Atrial fibrillation (AF) is a prevalent cardiac arrhythmia globally.
- Direct current cardioversion is a standard treatment to restore normal heart rhythm.
- Chest pressure may enhance cardioversion by reducing impedance and improving energy delivery.
Purpose of the Study:
- To evaluate the efficacy and safety of routine chest pressure during direct current cardioversion for AF.
- To compare cardioversion success rates between patients receiving chest pressure from the first shock versus standard care.
Main Methods:
- A multicentre, double-blind, randomized clinical trial was conducted.
- Patients were randomized to receive chest pressure from the first shock or on the final shock.
- Outcomes included total energy delivered, first shock success, transthoracic impedance, and rhythm at 1 minute post-shock.
Main Results:
- The study aimed to assess the impact of chest pressure on key cardioversion parameters.
- Data on total energy provided, first shock success, and transthoracic impedance were collected.
- Sinus rhythm at 1 minute post-cardioversion was the primary success measure.
Conclusions:
- The findings will determine if routine chest pressure is a beneficial adjunct to direct current cardioversion for AF.
- This research could influence clinical practice guidelines for AF management.
- The study prioritizes patient safety and treatment effectiveness.
Introduction:
Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Direct current cardioversion is commonly used to restore sinus rhythm in patients with AF. Chest pressure may improve cardioversion success through decreasing transthoracic impedance and increasing cardiac energy delivery. We aim to assess the efficacy and safety of routine chest pressure with direct current cardioversion for AF.
Methods And Analysis:
Multicentre, double blind (patient and outcome assessment), randomised clinical trial based in New South Wales, Australia. Patients will be randomised 1:1 to control and interventional arms. The control group will receive four sequential biphasic shocks of 150 J, 200 J, 360 J and 360 J with chest pressure on the last shock, until cardioversion success. The intervention group will receive the same shocks with chest pressure from the first defibrillation. Pads will be placed in an anteroposterior position. Success of cardioversion will be defined as sinus rhythm at 1 min after shock. The primary outcome will be total energy provided. Secondary outcomes will be success of first shock to achieve cardioversion, transthoracic impedance and sinus rhythm at post cardioversion ECG.
Ethics And Dissemination:
Ethics approval has been confirmed at all participating sites via the Research Ethics Governance Information System. The trial has been registered on the Australia New Zealand Clinical Trials Registry (ACTRN12620001028998). De-identified patient level data will be available to reputable researchers who provide sound analysis proposals.
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