Walsh Simon J, McCarty David, McClelland Anthony J J, Owens Colum G, Trouton Tom G, Harbinson Mark T, O'Mullan Siobhan, McAllister Andrew, McClements Brian M, Stevenson Mike, Dalzell Gavin W N, Adgey A A Jennifer
Regional Medical Cardiology Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
Eur Heart J. 2005 Jul;26(13):1298-302. doi: 10.1093/eurheartj/ehi196. Epub 2005 Apr 11.
To compare the success rate for transthoracic direct current cardioversion (DCC) of atrial fibrillation (AF) with antero-posterior (AP) and antero-apical (AA) electrode positions using an impedance compensated biphasic (ICB) waveform.
Three-hundred and seven patients [mean age 66 (SD+/-13), 195 male] with AF were recruited in three centres. Patients were randomized to an AA (n=150) or AP (n=144) pad position. Thirteen patients with implanted pacemakers were defaulted to the AP pad position. Cardioversion was performed using an ICB waveform with a 70, 100, 150, and 200 J energy selection protocol. If the fourth shock was unsuccessful, the pads were crossed over to the alternative position for a final 200 J shock. Shock 1 was successful in 54/150 (36%) AA and 45/144 (31%) AP patients, whereas success was achieved by shock 2 in 99/150 (66%) AA and 74/144 (51%) AP, by shock 3 in 123/150 (82%) AA and 109/144 (76%) AP, and by shock 4 in 143/150 (95%) AA and 127/144 (88%) AP and after cross-over in 144/150 (96%) AA and 135/144 (94%) AP. Overall success rate was higher than expected at 95%. Pad position was not associated significantly with success. There was a trend towards an improved outcome with the AA configuration (P=0.05).
The influence of pad position for DCC of AF may be less pertinent with ICB waveforms than with monophasic waveforms.
使用阻抗补偿双相（ICB）波形，比较心房颤动（AF）经胸直流电复律（DCC）时前后位（AP）和前尖位（AA）电极位置的成功率。
三个中心招募了307例AF患者[平均年龄66（标准差±13），男性195例]。患者被随机分配至AA组（n = 150）或AP组（n = 144）的电极片位置。13例植入起搏器的患者被默认至AP电极片位置。使用具有70、100、150和200 J能量选择方案的ICB波形进行复律。如果第四次电击未成功，则将电极片交叉至另一位置进行最后一次200 J电击。第一次电击在54/150（36%）的AA组和45/144（31%）的AP组患者中成功，而第二次电击在99/150（66%）的AA组和74/144（51%）的AP组患者中成功，第三次电击在123/150（82%）的AA组和109/144（76%）的AP组患者中成功，第四次电击在143/150（95%）的AA组和127/144（88%）的AP组患者中成功，交叉后在144/150（96%）的AA组和135/144（94%）的AP组患者中成功。总体成功率高于预期，为95%。电极片位置与成功率无显著相关性。AA配置有改善结局的趋势（P = 0.05）。
与单相波形相比，ICB波形下AF的DCC电极片位置影响可能较小。
