A comparison of 50-J versus 100-J shocks for direct-current cardioversion of atrial flutter
Abstract
Background Direct-current cardioversion remains the gold standard for restoration of sinus rhythm in patients with atrial flutter. Although an initial energy of 50 J is recommended, the optimal energy settings have not been evaluated in a large series of contemporary patients.Methods We compared the outcome of cardioversion with 50 J versus 100 J in 330 consecutive patients with atrial flutter. Initial energy was based on attending physician preference. One hundred sixty patients received 50 J and 170 patients received 100 J.Results Patients in both groups did not differ significantly in age, sex, weight, body mass index, duration of the arrhythmia, postoperative status, presence and type of structural heart disease, or use of antiarrhythmic drugs. Patients in the 100-J group had more first shock conversion (85% vs 70%; P =. 001), fewer total shocks (1.2 +/- 0.5 vs 1.4 +/- 0.7; P =.001), and less induction of atrial fibrillation (2% vs 11%; P =.002). There were no significant differences in overall restoration of sinus rhythm, cumulative energy delivered, anesthetic dose, and procedure room time. On multivariate analysis, delivery of 100 J was the strongest predictor of first shock success (odds ratio 2.6, 95% confidence interval 2.13 to 3.16; P <.001).Conclusion An initial energy of 100 J is more efficient for restoration of sinus rhythm in patients with atrial flutter.
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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 [999]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
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- Authors
- Pinski, S. L., Sgarbossa, E. B., Ching, E., & Trohman, R. G.
- Affiliations
- Cleveland Clinic (US)
- ORCID
- Trohman, Richard G.
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 1999-03
- Volume
- 137
- Issue
- 3
- Pages
- 439-442
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2021378492
- Cited by
- 45
- References
- 31
- Citations by year
- 2025: 1 · 2023: 3 · 2021: 2 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 7 · 2014: 2 · 2013: 1
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (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 flutter, electrical cardioversion, shock energy, sinus rhythm restoration, antiarrhythmic drugs, procedural efficiency
- MeSH terms
- Aged, Analysis of Variance, Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Cardiomyopathy, Dilated, Coronary Disease, Electric Countershock, Electricity, Female, Forecasting, Humans, Male, Methohexital, Middle Aged, Myocardial Contraction, Time Factors, Cohort Studies, Body Mass Index, Multivariate Analysis, Confidence Intervals, Odds Ratio, Treatment Outcome, Anesthetics, Intravenous
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