手动胸部按压在心房颤动直流电复律中的应用：一项随机对照试验（PRESSURE-AF）。

Manual Chest PRESSURE During Direct Current Cardioversion for Atrial Fibrillation: A Randomized Control Trial (PRESSURE-AF).

机构信息

Cardiovascular 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.

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

出版信息

JACC Clin Electrophysiol. 2024 Oct;10(10):2207-2213. doi: 10.1016/j.jacep.2024.05.037. Epub 2024 Sep 2.

DOI:10.1016/j.jacep.2024.05.037

PMID:39230541

Abstract

BACKGROUND

Direct current cardioversion is frequently used to return patients with atrial fibrillation (AF) to sinus rhythm. Chest pressure during cardioversion may improve the efficacy of cardioversion through decreasing transthoracic impedance and increasing cardiac energy delivery.

OBJECTIVES

This study aimed to assess the efficacy and safety of upfront chest pressure during direct current cardioversion for AF with anterior-posterior pad positioning.

METHODS

This was a multicenter, investigator-initiated, double-blinded, randomized clinical trial. Recruitment occurred from 2021 to 2023. Follow-up was until hospital discharge. Recruitment occurred across 3 centers in New South Wales, Australia. Inclusion criteria were age ≥18 years, referred for cardioversion for AF, and anticoagulation for 3 weeks or transesophageal echocardiography excluding left atrial appendage thrombus. Exclusion criteria were other arrhythmias requiring cardioversion, such as atrial flutter and atrial tachycardia. The intervention arm received chest pressure during cardioversion from the first shock. The primary efficacy outcome was total joules required per patient encounter. Secondary efficacy outcomes included first shock success, transthoracic impedance, cardioversion success, and sinus rhythm at 30 minutes post cardioversion.

RESULTS

A total of 311 patients were randomized, 153 to control and 158 to intervention. There was no difference in total joules applied per encounter in the control arm vs intervention arm (355.0 ± 301 J vs 413.8 ± 347 J; P = 0.19). There was no difference in first shock success, total shocks provided, average impedance, and cardioversion success.

CONCLUSIONS

This study does not support the routine application of chest pressure for direct current cardioversion in atrial fibrillation (PRESSURE-AF [Investigating the Efficacy of Chest Pressure for Direct Current Cardioversion in Atrial Fibrillation: A Randomized Controlled Trial]; ACTRN12620001028998).

摘要

背景

直流电复律常用于将心房颤动（AF）患者恢复窦性节律。复律时的胸部按压可通过降低胸阻抗和增加心脏能量传递来提高复律效果。

目的

本研究旨在评估前后位电极板定位直流电复律时，即刻施加胸部按压对 AF 的疗效和安全性。

方法

这是一项多中心、研究者发起的、双盲、随机临床试验。招募时间为 2021 年至 2023 年。随访至出院。招募地点为澳大利亚新南威尔士州的 3 个中心。纳入标准为年龄≥18 岁、因 AF 接受复律且抗凝治疗 3 周或经食管超声心动图排除左心耳血栓。排除标准为其他需要复律的心律失常，如房扑和房性心动过速。干预组在复律的第一电击时接受胸部按压。主要疗效结局为每位患者电击次数所需的总焦耳数。次要疗效结局包括首次电击成功率、胸阻抗、复律成功率和复律后 30 分钟窦性节律。

结果

共纳入 311 例患者，153 例分入对照组，158 例分入干预组。对照组和干预组电击次数所需的总焦耳数无差异（355.0±301 J 比 413.8±347 J；P=0.19）。两组首次电击成功率、总电击次数、平均阻抗和复律成功率无差异。

结论

本研究不支持常规应用胸部按压提高直流电复律治疗 AF 的效果（PRESSURE-AF [Investigating the Efficacy of Chest Pressure for Direct Current Cardioversion in Atrial Fibrillation: A Randomized Controlled Trial]；ACTRN12620001028998）。