| Title: |
Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial |
| Authors: |
Glover, B M; Walsh, S J; McCann, C J; Moore, M J; Manoharan, G; Dalzell, G W N; McAllister, A; McClements, B; McEneaney, D J; Trouton, T G; Mathew, T P; Adgey, A A J |
| Publisher Information: |
BMJ Publishing Group Ltd |
| Publication Year: |
2008 |
| Collection: |
HighWire Press (Stanford University) |
| Subject Terms: |
Original articles |
| Description: |
Aims: To compare the efficacy and safety of an escalating energy protocol with a non-escalating energy protocol using an impedance compensated biphasic defibrillator for direct current cardioversion of atrial fibrillation (AF). Methods and results: This prospective multicentre randomised trial enrolled 380 patients (248 male, mean (SD) age 67 (10) years) with AF. Patients were randomised to either an escalating energy protocol (protocol A: 100 J, 150 J, 200 J, 200 J), or a non-escalating energy protocol (protocol B: 200 J, 200 J, 200 J). Cardioversion was performed using an impedance compensated biphasic waveform. First-shock success was significantly higher for those randomised to 200 J than 100 J (71% vs 48%; p25 kg/m2 (75% vs 44%; p = 0.01). In patients with a normal BMI there was no significant difference in first-shock success. There was also no significant difference between subsequent shocks or overall success. The use of a non-escalating protocol (protocol B) resulted in fewer shocks but with a higher cumulative energy. There was no difference in duration of procedure, amount of sedation administered or post-shock erythema between the groups. Conclusion: First-shock success was significantly higher, particularly in patients with a BMI >25 kg/m2, when a non-escalating initial 200 J energy was selected. The overall success, duration of procedure and amount of sedation administered, however, did not differ significantly between the two protocols. |
| Document Type: |
text |
| File Description: |
text/html |
| Language: |
English |
| Relation: |
http://heart.bmj.com/cgi/content/short/94/7/884; http://dx.doi.org/10.1136/hrt.2007.120782 |
| DOI: |
10.1136/hrt.2007.120782 |
| Availability: |
http://heart.bmj.com/cgi/content/short/94/7/884; https://doi.org/10.1136/hrt.2007.120782 |
| Rights: |
Copyright (C) 2008, BMJ Publishing Group Ltd |
| Accession Number: |
edsbas.70F5A08B |
| Database: |
BASE |