scholarly journals Maximum-fixed energy shocks for cardioverting atrial fibrillation

2019 ◽  
Author(s):  
Anders S Schmidt ◽  
Kasper G Lauridsen ◽  
Peter Torp ◽  
Leif F Bach ◽  
Hans Rickers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Sinus Rhythm ◽  
Energy Group ◽  
Fixed Energy ◽  
Percentage Points ◽  
Direct Current Cardioversion ◽  
Significant Difference ◽  
Patient Reported ◽  
Safety Endpoint

Abstract Aims Direct-current cardioversion is one of the most commonly performed procedures in cardiology. Low-escalating energy shocks are common practice but the optimal energy selection is unknown. We compared maximum-fixed and low-escalating energy shocks for cardioverting atrial fibrillation. Methods and results In a single-centre, single-blinded, randomized trial, we allocated elective atrial fibrillation patients to cardioversion using maximum-fixed (360-360-360 J) or low-escalating (125-150-200 J) biphasic truncated exponential shocks. The primary endpoint was sinus rhythm 1 min after cardioversion. Safety endpoints were any arrhythmia, myocardial injury, skin burns, and patient-reported pain after cardioversion. We randomized 276 patients, and baseline characteristics were well-balanced between groups (mean ± standard deviation age: 68 ± 9 years, male: 72%, atrial fibrillation duration >1 year: 30%). Sinus rhythm 1 min after cardioversion was achieved in 114 of 129 patients (88%) in the maximum-fixed energy group, and in 97 of 147 patients (66%) in the low-escalating energy group (between-group difference; 22 percentage points, 95% confidence interval 13–32, P < 0.001). Sinus rhythm after first shock occurred in 97 of 129 patients (75%) in the maximum-fixed energy group compared to 50 of 147 patients (34%) in the low-escalating energy group (between-group difference; 41 percentage points, 95% confidence interval 30–51). There was no significant difference between groups in any safety endpoint. Conclusion Maximum-fixed energy shocks were more effective compared with low-escalating energy shocks for cardioverting atrial fibrillation. We found no difference in any safety endpoint.

Abstract 25: Accuracy of Patient Identification of Atrial Fibrillation in the Clinic Setting

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Jeffrey L Turner ◽  
Benjamin E Hardisty ◽  
Gagandeep Kaur ◽  
Rashmee U Shah ◽  
Mihail G Chelu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Patient Reported Outcome ◽  
Clinic Visit ◽  
Patient Identification ◽  
Significant Difference ◽  
Patient Reported ◽  
Appropriate Therapy ◽  
Electrocardiogram Ecg ◽  
Atrial Rhythm

Background: Atrial fibrillation (AF) related symptoms are commonly reported but often difficult to directly correlate with arrhythmia. Given that symptoms largely drive management, correct patient awareness of AF is critical to implementation of appropriate therapy. Objective: To determine accuracy of patient identification of their own atrial rhythm. Methods: All AF patients in our center undergo patient reported outcome assessment with the Toronto AF Severity Scale (AFSS) immediately prior to clinic visit. Using the validated questions from the AFSS, we assessed if patients were able to accurately determine their rhythm (AF or not) compared to an electrocardiogram (ECG) during the same clinic visit. Results: We identified 254 unique patients (Table 1) with interpretable ECG and AFSS data available from the same visit. Based on ECG, 81% (n=206) were not in AF. 20 of these 206 patients (9.7%) incorrectly identified themselves in AF (Figure 1). Patients who incorrectly thought they were in AF were significantly older (p<0.05). Of the 48 (18.9%) that were in AF by ECG, 15 (31.2%) incorrectly identified themselves in sinus rhythm. There was no significant difference between sex, age or mean heart rate in patients in AF. Overall 14% (35 of 254) provided an assessment that was inconsistent with their ECG. Conclusion: Approximately one of ten patients incorrectly identified themselves as being in AF despite being in sinus rhythm. Without a standardized method to confirm if symptoms truly correlate with AF these patients may be at risk for unnecessary antiarrhythmic therapies. On the contrary, nearly a third of patients were unaware of AF which reemphasizes the incidence of asymptomatic AF.

scholarly journals Anterior-Lateral Versus Anterior-Posterior Electrode Position for Cardioverting Atrial Fibrillation

Circulation ◽  
2021 ◽  
Author(s):  
Anders Sjørslev Schmidt ◽  
Kasper Glerup Lauridsen ◽  
Dorthe Svenstrup Møller ◽  
Per Dahl Christensen ◽  
Karen Kaae Dodt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Sinus Rhythm ◽  
Primary Outcome ◽  
Risk Difference ◽  
Electrode Position ◽  
Percentage Points ◽  
Safety Outcomes ◽  
Anterior Posterior ◽  
Posterior Electrode

Background: Smaller randomized studies have reported conflicting results regarding the optimal electrode position for cardioverting atrial fibrillation. However, anterior-posterior electrode position is widely used as a standard and believed to be superior to anterior-lateral electrode position. Therefore, we aimed to compare anterior-lateral and anterior-posterior electrode position for cardioverting atrial fibrillation in a multicenter randomized trial. Methods: In this multicenter, investigator-initiated, open-label trial, we randomly assigned patients with atrial fibrillation scheduled for elective cardioversion to anterior-lateral or anterior-posterior electrode position. The primary outcome was the proportion of patients in sinus rhythm after the first shock. The secondary outcome was the proportion of patients in sinus rhythm after up to four shocks escalating to maximum energy. Safety outcomes were any cases of arrhythmia during or after cardioversion, skin redness, and patient-reported peri-procedural pain. Results: We randomized 468 patients. The primary outcome occurred in 126 patients (54%) assigned to anterior-lateral electrode position and in 77 patients (33%) assigned to anterior-posterior electrode position, a risk difference of 22 percentage-points, 95%-confidence interval: 13-30, P<0.001. The number of patients in sinus rhythm after the final cardioversion shock was 216 patients (93%) assigned to anterior−lateral electrode position and 200 patients (85%) assigned to anterior-posterior electrode position, a risk difference of 7 percentage−points, 95%−confidence interval: 2−12. There were no significant differences between groups in any safety outcomes. Conclusions: Anterior-lateral electrode position was more effective than anterior-posterior electrode position for biphasic cardioversion of atrial fibrillation. There were no significant differences in any safety outcome.

scholarly journals Use of a Medical-Alert Accessory in CKD

2019 ◽  
Vol 14 (7) ◽  
pp. 994-1001 ◽  
Author(s):  
Eli Farhy ◽  
Clarissa Jonas Diamantidis ◽  
Rebecca M. Doerfler ◽  
Wanda J. Fink ◽  
Min Zhan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Usual Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Interquartile Range ◽  
Observation Group ◽  
Significant Difference ◽  
Patient Reported ◽  
Class 1

Background and objectivesPoor disease recognition may jeopardize the safety of CKD care. We examined safety events and outcomes in patients with CKD piloting a medical-alert accessory intended to improve disease recognition and an observational subcohort from the same population.Design, setting, participants, & measurementsWe recruited 350 patients with stage 2–5 predialysis CKD. The first (pilot) 108 participants were given a medical-alert accessory (bracelet or necklace) indicating the diagnosis of CKD and displaying a website with safe CKD practices. The subsequent (observation) subcohort (n=242) received usual care. All participants underwent annual visits with ascertainment of patient-reported events (class 1) and actionable safety findings (class 2). Secondary outcomes included 50% GFR reduction, ESKD, and death. Cox proportional hazards assessed the association of the medical-alert accessory with outcomes.ResultsMedian follow-up of pilot and observation subcohorts were 52 (interquartile range, 44–63) and 37 (interquartile range, 27–47) months, respectively. The frequency of class 1 and class 2 safety events reported at annual visits was not different in the pilot versus observation group, with 108.7 and 100.6 events per 100 patient-visits (P=0.13), and 38.3 events and 41.2 events per 100 patient visits (P=0.23), respectively. The medical-alert accessory was associated with lower crude and adjusted rate of ESKD versus the observation group (hazard ratio, 0.42; 95% confidence interval, 0.20 to 0.89; and hazard ratio, 0.38; 95% confidence interval, 0.16 to 0.94, respectively). The association of the medical-alert accessory with the composite endpoint of ESKD or 50% reduction GFR was variable over time but appeared to have an early benefit (up to 23 months) with its use. There was no significant difference in incidence of hospitalization, death, or a composite of all outcomes between medical-alert accessory users and the observational group.ConclusionsThe medical-alert accessory was not associated with incidence of safety events but was associated with a lower rate of ESKD relative to usual care.

64Risk of dementia in patients treated with non-vitamin k antagonist oral anticoagulant or warfarin for nonvalvular atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Kim ◽  
P S Yang ◽  
E Jang ◽  
H T Yu ◽  
T H Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Vascular Dementia ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Alzheimer Dementia ◽  
Significant Difference ◽  
Korean Ministry ◽  
Prior Stroke

Abstract Background Evidence is accumulating that use of oral anticoagulants (OACs) decreases the risk of dementia in patients with atrial fibrillation (AF), but it is unclear if there is a difference between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in protecting against dementia. Purpose To compare the risk of dementia between patients taking either NOAC or warfarin using a nationwide cohort data covering the entire Korean population. Methods Using the Korean national health insurance service database, 68,984 new OAC users with non-valvular AF aged ≥50 years and no prior diagnosis of dementia were identified during the period of 2013–2016 (39,687 NOAC users and 29,297 warfarin users). Starting from OAC initiation, participants were followed up until the date of dementia, death, or December 31, 2016. We compared the rates of dementia in 1:1 propensity score-matched cohorts of NOAC (n=18,925) and warfarin users (n=18,925). Results During the 52,259 person-years of follow-up, there were 2,750 dementia events. Use of NOAC was associated with significant lower risk of dementia [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.69–0.81], compared with warfarin. The risk reduction was prominent for vascular dementia (HR 0.60, 95% CI 0.52–0.71), whereas there was no significant difference in the risk of Alzheimer dementia (HR 0.92, 95% CI 0.83–1.02). Restricting the analyses to patients with no stroke diagnosis prior to OAC initiation (primary prevention) showed no significant difference between NOAC and warfarin in any types of dementia, but in the subgroup with prior stroke (secondary prevention), NOAC significantly reduced the risk of overall (HR 0.70, 95% CI 0.63–0.78) and vascular dementia (HR 0.59, 95% CI 0.49–0.69). Subgroup analysis according to stroke Hx Patient N Overall dementia Alzheimer dementia Vascular dementia HR (95% CI) P for interaction HR (95% CI) P for interaction HR (95% CI) P for interaction Total 37,850 0.75 (0.69–0.81) 0.92 (0.83–1.02) 0.60 (0.52–0.71) Without prior stroke 24,773 0.90 (0.78–1.05) 0.948 0.98 (0.83–1.15) 0.235 0.85 (0.56–1.28) 0.863 With prior stroke 13,077 0.70 (0.63–0.78) 0.90 (0.79–1.03) 0.59 (0.49–0.69) CI, confidence interval; HR, hazard ratio. KM curves of dementia incidence Conclusion In this propensity-weighted nationwide cohort of non-valvular AF patients, NOAC was associated with reduced risk of dementia, compared with warfarin. This association was the most pronounced for vascular dementia in patients with prior stroke. Acknowledgement/Funding The Korean Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and the Korean Ministry of Health & Welfare (HI16C0058, HI15C1200)

Usefulness of the Atrial Emptying Fraction to Predict Maintenance of Sinus Rhythm After Direct Current Cardioversion for Atrial Fibrillation

2016 ◽  
Vol 118 (9) ◽  
pp. 1345-1349 ◽  
Author(s):  
Christina L. Luong ◽  
Darby J.S. Thompson ◽  
Kenneth G. Gin ◽  
John Jue ◽  
Parvathy Nair ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Direct Current ◽  
Direct Current Cardioversion

scholarly journals Investigating the efficacy of chest pressure for direct current cardioversion in atrial fibrillation: a randomised control trial protocol (Pressure-AF)

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001739
Author(s):  
David Ferreira ◽  
Philo Mikhail ◽  
Michael McGee ◽  
Andrew Boyle ◽  
Aaron Sverdlov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Direct Current ◽  
Intervention Group ◽  
Randomised Clinical Trial ◽  
Randomised Control Trial ◽  
Control Group ◽  
Double Blind ◽  
Transthoracic Impedance ◽  
Direct Current Cardioversion

IntroductionAtrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Direct current cardioversion is commonly used to restore sinus rhythm in patients with AF. Chest pressure may improve cardioversion success through decreasing transthoracic impedance and increasing cardiac energy delivery. We aim to assess the efficacy and safety of routine chest pressure with direct current cardioversion for AF.Methods and analysisMulticentre, double blind (patient and outcome assessment), randomised clinical trial based in New South Wales, Australia. Patients will be randomised 1:1 to control and interventional arms. The control group will receive four sequential biphasic shocks of 150 J, 200 J, 360 J and 360 J with chest pressure on the last shock, until cardioversion success. The intervention group will receive the same shocks with chest pressure from the first defibrillation. Pads will be placed in an anteroposterior position. Success of cardioversion will be defined as sinus rhythm at 1 min after shock. The primary outcome will be total energy provided. Secondary outcomes will be success of first shock to achieve cardioversion, transthoracic impedance and sinus rhythm at post cardioversion ECG.Ethics and disseminationEthics approval has been confirmed at all participating sites via the Research Ethics Governance Information System. The trial has been registered on the Australia New Zealand Clinical Trials Registry (ACTRN12620001028998). De-identified patient level data will be available to reputable researchers who provide sound analysis proposals.

scholarly journals Thoracoscopic infrared ablation to create a box lesion as a treatment for atrial fibrillation

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Hiroshi Kubota ◽  
Toshiya Ohtsuka ◽  
Mikio Ninomiya ◽  
Takahiro Nonaka ◽  
Motoyuki Hisagi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial Appendage ◽  
Thoracoscopic Surgery ◽  
Posterior Wall ◽  
Beating Heart ◽  
Bottom Line ◽  
Case Presentation ◽  
Permanent Atrial Fibrillation ◽  
Direct Current Cardioversion

Abstract Background Creating a box lesion in the posterior wall of the left atrium from the epicardial side of the beating heart remains a challenge. Although a transmural lesion can be created by applying radiofrequency (RF) energy at clampable sites, it is still difficult to create a transmural lesion at unclampable sites because the inner blood flow in the unclampable free wall weakens the thermal effect on the outside. Our aim was to apply the newly developed infrared coagulator to create linear transmural lesions on the beating heart thoracoscopically to treat atrial fibrillation (AF). Case presentation A 71-year-old male was referred to our hospital with a diagnosis of hypertrophic cardiomyopathy and permanent atrial fibrillation. The patient was first diagnosed with atrial fibrillation 20 years before. Direct current cardioversion had been performed every few years a total of four times, but sinus rhythm restoration had always been temporary. On February 27, 2020, thoracoscopic PV isolation together with infrared roof- and bottom-line ablation to create a box lesion and left atrial appendage amputation (LAAA) were performed. The coagulator could be applied to clinical thoracoscopic surgery to successfully create a box lesion without any complication. The patient restored a regular sinus rhythm, it has been maintained for eleven months, and there have been no adverse events. Conclusions The infrared coagulator might have enough potential to create transmural lesions on the beating heart in thoracoscopic AF surgery.

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