A stepwise external cardioversion protocol for atrial fibrillation to maximize acute success rate

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Persistent atrial fibrillation (AF) management often requires cardioversion.
• Existing protocols for failed external electrical cardioversion are not well-defined.

Purpose of the Study:

• To evaluate the efficacy of a pre-defined stepwise cardioversion protocol for persistent AF (≤12 months duration).
• To determine the success rate and safety of the proposed protocol.

Main Methods:

• A stepwise protocol involving electrode placement, expiratory compression, and dual defibrillator energy was applied.
• 414 patients with persistent AF (≤12 months) were included.

Main Results:

• An overall success rate of 99.3% was achieved in restoring sinus rhythm.
• Only 12.5% of patients required multiple cardioversion attempts.
• High body mass index predicted the need for multiple attempts; high transthoracic impedance correlated with failed cardioversion.
• No major complications were reported.

Conclusions:

• The stepwise cardioversion protocol demonstrates a high success rate (>99%) for persistent AF.
• The protocol is safe for use in both outpatient and inpatient settings.
• This approach offers an effective rhythm management strategy for AF patients.