Manual Chest PRESSURE During Direct Current Cardioversion for Atrial Fibrillation: A Randomized Control Trial (PRESSURE-AF).

atrial fibrillation cardioversion chest pressure

Journal

JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995

Informations de publication

Date de publication:
22 Jul 2024
Historique:
received: 03 01 2024
revised: 07 05 2024
accepted: 30 05 2024
medline: 4 9 2024
pubmed: 4 9 2024
entrez: 4 9 2024
Statut: aheadofprint

Résumé

Direct current cardioversion is frequently used to return patients with atrial fibrillation (AF) to sinus rhythm. Chest pressure during cardioversion may improve the efficacy of cardioversion through decreasing transthoracic impedance and increasing cardiac energy delivery. This study aimed to assess the efficacy and safety of upfront chest pressure during direct current cardioversion for AF with anterior-posterior pad positioning. This was a multicenter, investigator-initiated, double-blinded, randomized clinical trial. Recruitment occurred from 2021 to 2023. Follow-up was until hospital discharge. Recruitment occurred across 3 centers in New South Wales, Australia. Inclusion criteria were age ≥18 years, referred for cardioversion for AF, and anticoagulation for 3 weeks or transesophageal echocardiography excluding left atrial appendage thrombus. Exclusion criteria were other arrhythmias requiring cardioversion, such as atrial flutter and atrial tachycardia. The intervention arm received chest pressure during cardioversion from the first shock. The primary efficacy outcome was total joules required per patient encounter. Secondary efficacy outcomes included first shock success, transthoracic impedance, cardioversion success, and sinus rhythm at 30 minutes post cardioversion. A total of 311 patients were randomized, 153 to control and 158 to intervention. There was no difference in total joules applied per encounter in the control arm vs intervention arm (355.0 ± 301 J vs 413.8 ± 347 J; P = 0.19). There was no difference in first shock success, total shocks provided, average impedance, and cardioversion success. This study does not support the routine application of chest pressure for direct current cardioversion in atrial fibrillation (PRESSURE-AF [Investigating the Efficacy of Chest Pressure for Direct Current Cardioversion in Atrial Fibrillation: A Randomized Controlled Trial]; ACTRN12620001028998).

Sections du résumé

BACKGROUND BACKGROUND
Direct current cardioversion is frequently used to return patients with atrial fibrillation (AF) to sinus rhythm. Chest pressure during cardioversion may improve the efficacy of cardioversion through decreasing transthoracic impedance and increasing cardiac energy delivery.
OBJECTIVES OBJECTIVE
This study aimed to assess the efficacy and safety of upfront chest pressure during direct current cardioversion for AF with anterior-posterior pad positioning.
METHODS METHODS
This was a multicenter, investigator-initiated, double-blinded, randomized clinical trial. Recruitment occurred from 2021 to 2023. Follow-up was until hospital discharge. Recruitment occurred across 3 centers in New South Wales, Australia. Inclusion criteria were age ≥18 years, referred for cardioversion for AF, and anticoagulation for 3 weeks or transesophageal echocardiography excluding left atrial appendage thrombus. Exclusion criteria were other arrhythmias requiring cardioversion, such as atrial flutter and atrial tachycardia. The intervention arm received chest pressure during cardioversion from the first shock. The primary efficacy outcome was total joules required per patient encounter. Secondary efficacy outcomes included first shock success, transthoracic impedance, cardioversion success, and sinus rhythm at 30 minutes post cardioversion.
RESULTS RESULTS
A total of 311 patients were randomized, 153 to control and 158 to intervention. There was no difference in total joules applied per encounter in the control arm vs intervention arm (355.0 ± 301 J vs 413.8 ± 347 J; P = 0.19). There was no difference in first shock success, total shocks provided, average impedance, and cardioversion success.
CONCLUSIONS CONCLUSIONS
This study does not support the routine application of chest pressure for direct current cardioversion in atrial fibrillation (PRESSURE-AF [Investigating the Efficacy of Chest Pressure for Direct Current Cardioversion in Atrial Fibrillation: A Randomized Controlled Trial]; ACTRN12620001028998).

Identifiants

DOI: 10.1016/j.jacep.2024.05.037 PMID: 39230541
pubmed: 39230541
pii: S2405-500X(24)00487-0
doi: 10.1016/j.jacep.2024.05.037
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Sverdlov has received grants from the National Heart Foundation of Australia Future Leader Fellowship (award ID 106025) and the NSW Health Cardiovascular Capacity Building Grant. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Auteurs

David Ferreira (D)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia. Electronic address: David.Ferreira@health.nsw.gov.au.

Philopatir Mikhail (P)

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

Joyce Lim (J)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

Max Ray (M)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

Jovita Dwivedi (J)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

Stephen Brienesse (S)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

Lloyd Butel-Simoes (L)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

William Meere (W)

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

Adam Bland (A)

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

Niklas Howden (N)

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

Michael Malaty (M)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

Mercy Kunda (M)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

Amy Kelty (A)

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

Michael McGee (M)

Cardiology Department, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia.

Andrew Boyle (A)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

Aaron L Sverdlov (AL)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

Maged William (M)

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

John Attia (J)

Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

Nicholas Jackson (N)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

Gwilym Morris (G)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

Malcolm Barlow (M)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.

James Leitch (J)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

Nicholas Collins (N)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

Tom Ford (T)

Cardiology Department, Gosford Hospital, Gosford, New South Wales, Australia.

Bradley Wilsmore (B)

Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.

Classifications MeSH