Personalizing configuration for atrial fibrillation external electrical cardioversion to improve first shock efficacy

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Biphasic electrical cardioversion (ECV) is commonly used for atrial fibrillation (AF) conversion.
• Current recommendations for electrode configuration in ECV are lacking.
• This study addresses the need for evidence-based guidance on electrode selection.

Purpose of the Study:

• To compare the efficacy of antero-apical pads (AAP) and antero-posterior adhesive patches (APP) for ECV in AF patients.
• To develop and validate a decision algorithm for personalizing ECV electrode configuration.
• To optimize ECV success rates and reduce energy requirements.

Main Methods:

• A quasi-experimental design was employed, enrolling all candidates for ECV for AF.
• The study involved two stages: initial comparison of AAP and APP, followed by validation of a developed decision algorithm.
• Patient data, including body surface area (BSA), height, and weight, were analyzed to inform the algorithm.

Main Results:

• Both APP and AAP configurations showed similar initial conversion rates (86.9% vs. 87.4%).
• BSA was an independent predictor of success; height (≤1.73m) was significant for AAP, while weight (<83kg) was significant for APP.
• The validated algorithm improved first shock efficacy (93.2% vs. 87.2%) and significantly reduced shock impedance (70.8 ± 15.3 vs. 81.8 ± 15.6).

Conclusions:

• Patient characteristics like BSA, height, and weight influence the choice of electrode configuration for ECV in AF.
• A personalized approach using a decision algorithm can optimize ECV outcomes.
• These findings offer potential for improving the clinical practice of ECV for AF management.