Kirchhof Paulus, Mönnig Gerold, Wasmer Kristina, Heinecke Achim, Breithardt Günter, Eckardt Lars, Böcker Dirk
Department of Cardiology and Angiology, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany.
Eur Heart J. 2005 Jul;26(13):1292-7. doi: 10.1093/eurheartj/ehi160. Epub 2005 Feb 25.
External electrical cardioversion is the method of choice to terminate persistent atrial fibrillation. Whether the type of shock electrode affects cardioversion success is not known. We tested whether hand-held steel electrodes improve cardioversion outcome with monophasic or biphasic shocks when compared with adhesive patch electrodes.
Two hundred and one consecutive patients with persistent atrial fibrillation (147 male, mean age 63+/-1 years, duration of atrial fibrillation 6.3+/-1 months) were randomly assigned to cardioversion using either a sinusoidal monophasic or a truncated exponential biphasic shock wave form. The first half of patients were cardioverted using adhesive patch electrodes, the second half using hand-held steel paddle electrodes, and all patients using an anterior-posterior electrode position. Paddle electrodes successfully cardioverted 100/104 patients (96%) and patch electrodes 85/97 patients (88%, P=0.04). This effect was comparable to that of biphasic shocks: biphasic shocks cardioverted 102/104 patients (98%) and monophasic shocks 83/97 patients (86%, P=0.001). A beneficial effect of paddle electrodes was observed for both shock wave forms. After cross-over from an ineffective monophasic to a biphasic shock, cardioversion was successful in 198/201 (98.5%) patients. Unsuccessful cardioversion after cross-over (3/201 patients) only occurred with patch electrodes (P=0.07).
Hand-held paddle electrodes increase success of external cardioversion of atrial fibrillation in this trial. This increase is of similar magnitude as the increase in cardioversion success achieved with biphasic shocks. A combination of biphasic shocks, paddle electrodes, and an anterior-posterior electrode position renders outcome of external cardioversion almost always successful (104/104 patients in this trial).
体外电复律是终止持续性心房颤动的首选方法。电击电极类型是否会影响复律成功率尚不清楚。我们测试了与粘性贴片电极相比，手持钢电极在单相或双相电击时是否能改善复律结果。
连续201例持续性心房颤动患者（147例男性，平均年龄63±1岁，房颤持续时间6.3±1个月）被随机分配接受正弦单相或截断指数双相电击波形进行复律。前一半患者使用粘性贴片电极进行复律，后一半使用手持钢片电极，所有患者均采用前后位电极放置。手持钢片电极成功复律100/104例患者（96%），贴片电极成功复律85/97例患者（88%，P = 0.04）。这种效果与双相电击相当：双相电击复律102/104例患者（98%），单相电击复律83/97例患者（86%，P = 0.001）。两种电击波形均观察到手持钢片电极的有益效果。从无效的单相电击转换为双相电击后，198/201（98.5%）例患者复律成功。转换后复律失败（3/201例患者）仅发生在贴片电极组（P = 0.07）。
在本试验中，手持钢片电极提高了心房颤动体外复律的成功率。这种提高的幅度与双相电击复律成功率的提高幅度相似。双相电击、手持钢片电极和前后位电极放置的组合使体外复律结果几乎总是成功（本试验中104/104例患者）。
