Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation:: a randomised trial
Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation:: a randomised trial
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DOI：
10.1016/s0140-6736(02)11315-8
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发表时间：
2002-10-26
期刊：
影响因子：
168.9
通讯作者：
Borggrefe, M
中科院分区：
文献类型：
--
作者：
Kirchhof, P;Eckardt, L;Borggrefe, M
背景体外复律是治疗持续性房颤的一种有效方法。尽管解剖学和电生理学考虑表明，前后电极位置应在整个心房内产生比前外侧位置更均匀的冲击场梯度，但在当前指南中，两种电极位置同样推荐用于体外心脏复律。我们进行了一项随机试验，比较两个位置与终点的成功cardioversion.Methods 108例连续患者（平均年龄60岁[SD 16]）持续性房颤（中位持续时间5个月，范围0.1-120）进行了选择性体外心脏复律的标准化逐步协议，增加电击强度（50-360 J）。电极位置被随机分配为前-外侧或前-后。如果使用360 J能量未实现窦性心律，则使用其他电极配置施加单次交叉电击（360 J）。在这些患者被招募后进行了计划的中期分析;这是通过意向治疗。结果心脏复律成功的比例在前-后组高于前-外侧组（50/52 [96%] vs 44/56 [78%]，差异23. 7%（95% CI 9. 1 - 37. 8，p= 0. 009）。在12名患者中，8名患者从前外侧到前后电极位置的交叉成功，而在另一个方向的交叉不成功（2名患者）。交叉后，复律成功102 108例随机患者（94%）。解释一个前-后电极位置是更有效的持续性房颤的外部复律比前-外侧位置。在临床实践中，除颤电极片的设计以及房颤复律指南更新时，应考虑这些结果。
Background External cardioversion is a readily available treatment for persistent atrial fibrillation. Although anatomical and electrophysiological considerations suggest that an anterior-posterior electrode position should create a more homogeneous shock-field gradient throughout the atria than an anterior-lateral position, both electrode positions are equally recommended for external cardioversion in current guidelines. We undertook a randomised trial comparing the two positions with the endpoint of successful cardioversion.Methods 108 consecutive patients (mean age 60 years [SD 16]) with persistent atrial fibrillation (median duration 5 months, range 0.1-120) underwent elective external cardioversion by a standardised step-up protocol with increasing shock strengths (50-360 J). Electrode positions were randomly assigned as anterior-lateral or anterior-posterior. If sinus rhythm was not achieved with 360 J energy, a single cross-over shock (360 J) was applied with the other electrode configuration. A planned interim analysis was done after these patients had been recruited; it was by intention to treat.Findings Cardioversion was successful in a higher proportion of the anterior-posterior than the anterior-lateral group (50 of 52 [96%] vs 44 of 56 [78%], difference 23.7% (95% CI 9.1-37.8, p=0.009). Cross-over from the anterior-lateral to the anterior-posterior electrode position was successful in eight of 12 patients, whereas cross-over in the other direction was not successful (two patients). After cross-over, cardioversion was successful in 102 of 108 randomised patients (94%).Interpretation An anterior-posterior electrode position is more effective than the anterior-lateral position for external cardioversion of persistent atrial fibrillation. These results should be considered in clinical practice, for the design of defibrillation electrode pads, and when guidelines for cardioversion of atrial fibrillation are updated.