The Impact of Patch Placement Using Fluoroscopy Guidance on Outcome of Electrical Cardioversion of Atrial Fibrillation

Authors

Joshua France, Oakland University William Beaumont School of Medicine Medical Student
Luai Madanat, Corewell Health East Fellow
Nolan Shoukri, Oakland University William Beaumont School of Medicine Medical Student
Daniel Walsh, Corewell Health East
Ilana Kutinsky, Corewell Health East
Sujana Gundlapalli, Corewell Health East
Abhay Bilolikar, Corewell Health East
Anil Kumar Anil, Corewell Health East
Brian Williamson, Corewell Health East
Elvis Cami, Corewell Health East
Michael Gallagher, Corewell Health East
Richard Bloomingdale, Corewell Health East
David E. Haines, Corewell Health East
Nishaki Mehta, Corewell Health East

Files

Keywords

Atrial fibrillation

Disciplines

Cardiology

Description

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and is Conclusions increasing in prevalence, especially as the population ages.1 Proper management of AF is imperative to prevent long-term complications including hemodynamic impairment and thromboembolic events which result in significant morbidity, mortality, and health care cost.2 Electrical cardioversion (EC) is frequently used to restore sinus rhythm in patients with AF.3, 4 However, it can be unsuccessful in up to 10-12% of patients.5 Despite the increased utilization of EC for the treatment of AF, guidelines provide little procedural guidance on methods to maximize EC success rates. Current European and American guidelines recommend positioning the cardioversion patches in the anterior-posterior configuration.4, 6 However, many have challenged this, as recommendations were primarily derived from prior studies using monophasic defibrillators,7, 8 which are rarely used in current clinical practice.4, 9-11 Similarly, the optimal starting energy for biphasic defibrillators is unclear with studies utilizing varying energies ranging from 100-360J.5, 9-12 Indeed, current guidelines and consensus do not provide specific recommendations on the starting energy level or energy escalation strategies when using biphasic defibrillators for AF.6, 13 Application of external force, also known as manual pressure augmentation (MPA), has been shown to reduce transthoracic impedance (TTI) and help facilitate shock delivery.14,15In cases of EC failure, re-attempting with different patch positioning (switching between anterior-posterior and anterior-lateral), energy escalation and application of external pressure on cardioversion patches have been suggested.6 The lack of clear-cut evidence on the optimal EC procedural approach likely contributes to the high variability in EC techniques and success rates among different centers. Establishing evidence-based procedural factors that help improve outcomes is essential to improve patient care and reduce the burden of AF on our health system. Therefore, we conducted a study investigating the effect of cardioversion patch distances relative to the cardiac silhouette on AF EC success.

Publication Date

5-2024

Recommended Citation

France J, Madanat L, Shoukri N, Walsh D, Kutinsky I, Gundlapalli S [Bilolikar A, Anil AK, Williamson B, Cami E, Gallagher M, Bloomingdale R, Haines DE, Mehta N] The impact of patch placement using fluoroscopy guidance on outcome of electrical cardioversion of atrial fibrillation. Poster presented at: Oakland University William Beaumont School of Medicine Embark Capstone Colloquium; 2024 May; Rochester Hills, MI.

Comments

The Embark Capstone Colloquium at the Oakland University William Beaumont School of Medicine, Rochester Hills, MI, May, 2024.