[Electrode position in elective electrical cardioversion of atrial fibrillation. A randomized study].
OBJECTIVE
To compare the effectiveness of left anteroposterior (A-P) and apex-anterior (A-A) electrode position in the electrical cardioversion (ECV) of patients with atrial fibrillation (AF).


METHODS
Randomized clinical trial.


METHODS
ICU of a second-level hospital.


METHODS
Ambulatory AF patients admitted to ICU for ECV with biphasic shocks. Up to a maximum of 3 shocks (150-200-200 J) are given in the electrode position determined by random numbers, and if sinus rhythm (SR) is not restored, electrode position is changed and 2 additional 200 J shocks are allowed. Both electrode positions are analyzed and compared to determine which one allows restoration of SR with the lowest number of shocks and least energy.


RESULTS
Forty-six patients were included in the A-A group, and 45 in the A-P group. Sinus rhythm was restored in 92% of cases, although patients in the A-A group needed a lower number of shocks and less energy: 1 versus 2 shocks (p=0,003) and 150 versus 350 J (p=0.017). Only one out of 5 patients in whom the A-A position had failed was reverted to RS with the A-P position, whereas 10 out of 13 patients in which A-P position had failed were reverted in the A-A position (p=0.038).


CONCLUSIONS
The A-A position is more effective in the elective electrical cardioversion of atrial fibrillation, so we recommend this position as the first choice.
Muñoz-Martínez
T
T
Unidad de Cuidados Intensivos, Hospital Txagorritxu, Vitoria, España. tomas@arconte.jazzte.es
Castañeda-Saiz
A
A
Vinuesa-Lozano
C
C
Aretxabala-Kortajarena
N
N
Dudagoitia-Otaolea
J L
JL
Iribarren-Diarasarri
S
S
Ruiz-Zorrilla
J M
JM
Hernández-López
M
M
Castillo-Arenal
C
C
D001281:Atrial Fibrillation / Q000628:therapy*; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged