Optimization of initial energy for cardioversion of atrial tachyarrhythmias with biphasic shocks
Abstract
Objective Recommendations for optimal first-shock energies with biphasic waveforms are conflicting. We evaluated prospectively the relation between type and duration of atrial tachyarrhythmias and the probability of successful cardioversion with a specific biphasic shock waveform to develop recommendations for the initial energy setting aiming at the lowest total cumulative energy with 2 or less consecutive shocks.Methods We analyzed 453 consecutive patients undergoing their first transthoracic electrical cardioversion, including 358 attempts for atrial fibrillation (AF) and 95 attempts for atrial flutter (AFL) or atrial tachycardia (AT). A step-up protocol with a truncated exponential biphasic waveform starting at 50 J was used. Total cumulative energies were estimated under the assumption of a 2-tiered escalating shock protocol with different initial energy settings and a "rescue shock" of 250 J for AFL/AT or 360 J for AF. The initial energy setting leading to the lowest total cumulative energy was regarded as the optimal first-shock level.Results Cardioversion was successful in 448 patients (cumulative efficacy, 99 %). In patients with AFL/AT, the lowest total cumulative energy was attained with an initial energy setting of 50 J. In patients with AF, lowest values were achieved with an initial energy of 100 J for arrhythmia durations of 2 days or less and an initial energy of 150 J for arrhythmia durations of more than 2 days.Conclusion We recommend an initial energy setting of 50 J in patients with AFL/AT, of 100 J in patients with AF 2 days or less, and of 150 J with AF more than 2 days.
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Electrical cardioversion of atrial flutter can be performed using lower energies (50-100 J) than for AF.
“Electrical cardioversion of atrial flutter can be performed using lower energies (50-100 J) than for AF.998,999”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [998]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Reisinger, J., Gstrein, C., Winter, T., Zeindlhofer, E., Höllinger, K., Mori, M., Schiller, A., Winter, A., Geiger, H., & Siostrzonek, P.
- Affiliations
- Ordensklinikum Linz Barmherzige Schwestern (AT)
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2010-02
- Volume
- 28
- Issue
- 2
- Pages
- 159-165
- ISSN
- 0735-6757 (ISSN-L)
- OpenAlex
- W1986506402
- Cited by
- 44
- References
- 33
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 2 · 2017: 4 · 2016: 3 · 2015: 7 · 2014: 3 · 2012: 4
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, atrial flutter, atrial tachycardia, cumulative energy, arrhythmia duration
- MeSH terms
- Adult, Aged, Aged, 80 and over, Atrial Fibrillation, Atrial Flutter, Electric Countershock, Female, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Tachycardia, Ectopic Atrial, Multivariate Analysis, Logistic Models
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