None listed
Conditions
Brief summary
Chest pressure during direct current cardioversion reduces transthoracic resistance and increases cardiac energy delivery. This may decrease energy requirements, potentially increasing cardioversion success and reducing procedure time. The purpose of this study is to examine the efficacy of an initial strategy of chest pressure for direct current cardioversion for atrial fibrillation. Those enrolled will be randomised in a 1 to 1 ratio to the control or intervention arm. The intervention strategy will consist of up to three attempts of direct current cardioversion with chest pressure with increasing energy administered as follows: - 1 shock – 150 Joules with chest pressure - 1 shock – 200 Joules with chest pressure - 2 shocks – 360 Joules with chest pressure Manual chest pressure will be applied with gloves and a towel by the proceduralist (cardiologist/cardiology trainee) over the anterior pad. A maximum of four shocks will be provided until cardioversion success or failure, with a maximum energy of 360 Joules. The control strategy will consist of up to three attempts of direct current cardioversion with increasing energy administered as follows: - 1 shock – 150 Joules without chest pressure - 1 shock – 200 Joules without chest pressure - 1 shock - 360 Joules without chest pressure - 1 shock – 360 Joules with chest pressure A maximum of four shocks will be provided until cardioversion success or failure, with a maximum energy of 360 Joules.
Interventions
Participants will be randomised in a 1 to 1 ratio to an initial strategy of chest pressure with direct current cardioversion (intervention) or a strategy of chest pressure only if refractory to direct current cardioversion without pressure (control). Direct current cardioversion pads will be placed in an anterior-posterior position.
The intervention strategy will consist of up to four attempts of direct current cardioversion with increasing energy administered as follows:
- 1 shock – 150 Joules
Participants will be randomised in a 1 to 1 ratio to an initial strategy of chest pressure with direct current cardioversion (intervention) or a strategy of chest pressure only if refractory to direct current cardioversion without pressure (control). Direct current cardioversion pads will be placed in an anterior-posterior position. The intervention strategy will consist of up to four attempts of direct current cardioversion with increasing energy administered as follows: - 1 shock – 150 Joules with chest pressure - 1 shock – 200 Joules with chest pressure - 2 shocks – 360 Joules with chest pressure Manual chest pressure will be applied with gloves and a towel by the proceduralist (cardiologist/cardiology trainee) over the anterior pad. A maximum of four shocks will be provided until cardioversion success or failure, with a maximum energy of 360 Joules. Follow-up will be until hospital discharge, on the day of outpatient cardioversion. Data will be collected at the time of cardioversion by the proceduralist. Adherence to the study design and protocol will be monitored through review of the medical notes.
Sponsors
Cardiovascular Department, John Hunter Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Has atrial fibrillation Age 18 or older Referred for direct current cardioversion Three weeks of therapeutic anti-coagulation prior to cardioversion or trans-oesophageal echocardiography to exclude left atrial appendage thrombus.
Exclusion criteria
Pregnancy or Breastfeeding Inability to provide informed consent Other atrial tachyarrhythmias (atrial flutter of multifocal atrial tachycardia) Medical comorbidity where anticoagulation is contra-indicated
Outcome results
None listed