Alp N J, Rahman S, Bell J A, Shahi M
Cardiology Department, John Radcliffe Hospital, Headley Way, OX3 9DU, Oxford, UK.
Int J Cardiol. 2000 Sep 15;75(2-3):211-6. doi: 10.1016/s0167-5273(00)00326-0.
We designed a prospective, randomised, single-blind trial to compare the relative efficacy of antero-lateral versus antero-posterior paddle positions for DC cardioversion of persistent atrial fibrillation. A total of 59 patients were randomised to cardioversion using standard gel pads placed either in the antero-lateral (AL) or antero-posterior (AP) positions. The first synchronised shock was given at 360 J; if this was unsuccessful, a second shock of 360 J was given in the alternative position. We compared cardioversion success rate and energy requirements with each strategy. With the first 360 J DC shock, a significantly greater proportion of patients were restored to sinus rhythm from the antero-lateral position (18/30) compared to the antero-posterior position (10/29) (P=0.048). For those patients remaining in atrial fibrillation, there was no difference in the proportions cardioverted from the antero-lateral position (4/19) compared to the antero-posterior position (5/12) with the second 360 J DC shock (P=0. 22). The total cardioversion success rate was 23/30 (77%) for antero-lateral followed by antero-posterior shocks compared to a success rate of 14/29 (48%) for antero-posterior followed by antero-lateral shocks, and this difference was significant (P=0.024). There was no significant difference in the mean energy delivered for patients randomised to an initial antero-lateral shock (504 J), compared to patients given an initial antero-posterior shock (583 J) (P=0.1). We conclude that the antero-lateral paddle position appears more effective for DC cardioversion of persistent atrial fibrillation.
我们设计了一项前瞻性、随机、单盲试验，比较前外侧与前后位电极片位置用于持续性房颤直流电复律的相对疗效。共有59例患者被随机分为使用标准凝胶电极片进行复律，电极片分别置于前外侧（AL）或前后位（AP）。首次同步电击能量为360J；若不成功，则在另一位置给予360J的第二次电击。我们比较了每种策略的复律成功率和能量需求。首次360J直流电电击时，与前后位（10/29）相比，前外侧位置（18/30）有显著更多患者恢复窦性心律（P=0.048）。对于仍处于房颤的患者，第二次360J直流电电击时，前外侧位置（4/19）与前后位（5/12）复律的患者比例无差异（P=0.22）。前外侧电击后接着前后位电击的总复律成功率为23/30（77%），相比之下，前后位电击后接着前外侧电击的成功率为14/29（48%），且这种差异具有显著性（P=0.024）。随机接受初始前外侧电击的患者平均输送能量（504J）与接受初始前后位电击的患者（583J）相比，无显著差异（P=0.1）。我们得出结论，前外侧电极片位置对于持续性房颤的直流电复律似乎更有效。
