title: Comparison of antero-lateral versus antero-posterior electrode position for biphasic external cardioversion of atrial flutter.
abstract: External cardioversion is an established and very important tool to terminate symptomatic atrial flutter. The superiority of the biphasic waveform has been demonstrated for atrial flutter, but whether electrode position affects the efficacy of cardioversion in this population is not known. The aim of this trial was to evaluate whether anterior-lateral (A-L) compared with anterior-posterior (A-P) electrode position improves cardioversion results. Of 130 screened patients, 96 (72 men, mean age 62 +/- 12 years) were included and randomly assigned to a cardioversion protocol with either A-L or A-P electrode position. In each group, 48 patients received sequential biphasic waveform shocks using a step-up protocol consisting of 50, 75, 100, 150, or 200 J. The mean energy (65 +/- 13 J for A-L vs 77 +/- 13 J for A-P, p = 0.001) and mean number of shocks (1.48 +/- 1.01 for A-L vs 1.96 +/- 1.00 for A-P, p = 0.001) required for successful cardioversion were significantly lower in the A-L group. The efficacy of the first shock with 50 J in the A-L electrode position (35 of 48 patients [73%]) was also highly significantly greater than the first shock with 50 J in the A-P electrode position (18 of 48 patients [36%]) (p = 0.001). In conclusion, the A-L electrode position increases efficacy and requires fewer energy and shocks in external electrical cardioversion of common atrial flutter. Therefore, A-L electrode positioning should be recommended for the external cardioversion of common atrial flutter.
authors.affiliation: University Hospital Hamburg-Eppendorf, Heart Center, Department of Cardiology, Hamburg, Germany. risius@uke.uni-hamburg.de
authors.forename: Tim
authors.initials: T
authors.lastname: Risius
authors.forename: Kai
authors.initials: K
authors.lastname: Mortensen
authors.forename: Tjark F
authors.initials: TF
authors.lastname: Schwemer
authors.forename: Muhammet A
authors.initials: MA
authors.lastname: Aydin
authors.forename: Hanno U
authors.initials: HU
authors.lastname: Klemm
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Ventura
authors.forename: Achim
authors.initials: A
authors.lastname: Barmeyer
authors.forename: Boris
authors.initials: B
authors.lastname: Hoffmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
mesh_terms: D000368:Aged; D000465:Algorithms; D001282:Atrial Flutter / Q000628:therapy*; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome