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Effectiveness of dual external direct current cardioversion for initial cardioversion in atrial fibrillation
Author(s) -
Gardner Michael W.,
Yadava Mrinal,
Raitt Merritt H.,
Elman Miriam R.,
Zarraga Ignatius G.,
MacMurdy Karen S.,
Dalouk Khidir A.,
Jessel Peter M.
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13994
Subject(s) - medicine , cardioversion , atrial fibrillation , cardiology , hazard ratio , logistic regression , anesthesia , confidence interval
Dual external direct current cardioversion (dual‐DCCV) is a rhythm control strategy for persistent atrial fibrillation (AF), involving simultaneous delivery of two shocks from two defibrillators. The long‐term effectiveness of this approach has not been studied in the biphasic cardioversion era. Methods Seventy‐seven consecutive patients at a single center were identified to receive dual‐DCCV at the time of their initial cardioversion for AF, when maximum output standard external direct current cardioversion failed in two vectors. Logistic regression was used to analyze risk factors for dual‐DCCV in a historical control group of 77 patients undergoing standard cardioversion and Cox proportional hazard models were used to compare time to AF recurrence. Results The dual‐DCCV group had a significantly larger body mass index (BMI), but similar AF duration and left atrial size as controls. Multivariable logistic regression revealed that BMI and absence of prior paroxysmal AF were risk factors for dual‐DCCV ( P < 0.05). There was no difference observed between dual‐DCCV and control groups (adjusted hazard ratio = 0.57; P = .12) after adjusting for number of shocks and age. Transient hypoxia was the only acute complication in either group ( P > .999). Conclusion Dual‐DCCV appears to be a safe and effective cardioversion strategy for patients with AF. The need for dual‐DCCV in the treatment of AF appears to be influenced more by body habitus than atrial substrate.