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Manual Chest PRESSURE During Direct Current Cardioversion for Atrial Fibrillation: A Randomized Control Trial

David Ferreira1, Philopatir Mikhail2, Joyce Lim3

  • 1Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

JACC. Clinical Electrophysiology
|September 4, 2024
PubMed
Summary
This summary is machine-generated.

Applying chest pressure during direct current cardioversion for atrial fibrillation (AF) did not improve cardioversion success. This randomized trial found no significant difference in energy required or outcomes between groups, suggesting chest pressure is not routinely beneficial for AF cardioversion.

Keywords:
atrial fibrillationcardioversionchest pressure

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Direct current cardioversion is a common procedure for restoring sinus rhythm in patients with atrial fibrillation (AF).
  • Chest pressure during cardioversion is hypothesized to enhance efficacy by reducing transthoracic impedance and improving energy delivery.

Purpose of the Study:

  • To evaluate the efficacy and safety of applying upfront chest pressure during direct current cardioversion for atrial fibrillation (AF).
  • To assess the impact of chest pressure on energy requirements and cardioversion success rates.

Main Methods:

  • A multicenter, double-blinded, randomized clinical trial involving 311 patients undergoing cardioversion for AF.
  • Patients received either standard cardioversion or cardioversion with concurrent chest pressure using an anterior-posterior pad configuration.
  • Key outcomes included total joules, first shock success, transthoracic impedance, and cardioversion success at 30 minutes post-procedure.

Main Results:

  • No significant difference was observed in the total joules required per patient encounter between the control and chest pressure groups (355.0 ± 301 J vs 413.8 ± 347 J; P = 0.19).
  • First shock success, total shocks, average impedance, and overall cardioversion success rates were similar in both arms.

Conclusions:

  • The routine application of chest pressure during direct current cardioversion for atrial fibrillation is not supported by these findings.
  • The PRESSURE-AF trial indicates that chest pressure does not offer a significant benefit in improving cardioversion efficacy.