David Ferreira BMed , Philopatir Mikhail MBBS , Joyce Lim MBBS , Max Ray BMed , Jovita Dwivedi MBBS , Stephen Brienesse BMed , Lloyd Butel-Simoes MBBS , William Meere MBBS , Adam Bland MBBS , Niklas Howden MBBS , Michael Malaty MBBS , Mercy Kunda BNurs , Amy Kelty BNurs , Michael McGee MBBS , Andrew Boyle PhD , Aaron L. Sverdlov PhD , Maged William MBBS , John Attia PhD , Nicholas Jackson MBBS , Gwilym Morris PhD , Bradley Wilsmore PhD
{"title":"心房颤动直流电心脏起博过程中的手动胸部加压：随机对照试验（PRESSURE-AF）。","authors":"David Ferreira BMed , Philopatir Mikhail MBBS , Joyce Lim MBBS , Max Ray BMed , Jovita Dwivedi MBBS , Stephen Brienesse BMed , Lloyd Butel-Simoes MBBS , William Meere MBBS , Adam Bland MBBS , Niklas Howden MBBS , Michael Malaty MBBS , Mercy Kunda BNurs , Amy Kelty BNurs , Michael McGee MBBS , Andrew Boyle PhD , Aaron L. Sverdlov PhD , Maged William MBBS , John Attia PhD , Nicholas Jackson MBBS , Gwilym Morris PhD , Bradley Wilsmore PhD","doi":"10.1016/j.jacep.2024.05.037","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the efficacy and safety of upfront chest pressure during direct current cardioversion for AF with anterior-posterior pad positioning.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = 0.19). There was no difference in first shock success, total shocks provided, average impedance, and cardioversion success.</div></div><div><h3>Conclusions</h3><div>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]; <span><span>ACTRN12620001028998</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 10","pages":"Pages 2207-2213"},"PeriodicalIF":8.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Manual Chest PRESSURE During Direct Current Cardioversion for Atrial Fibrillation\",\"authors\":\"David Ferreira BMed , Philopatir Mikhail MBBS , Joyce Lim MBBS , Max Ray BMed , Jovita Dwivedi MBBS , Stephen Brienesse BMed , Lloyd Butel-Simoes MBBS , William Meere MBBS , Adam Bland MBBS , Niklas Howden MBBS , Michael Malaty MBBS , Mercy Kunda BNurs , Amy Kelty BNurs , Michael McGee MBBS , Andrew Boyle PhD , Aaron L. Sverdlov PhD , Maged William MBBS , John Attia PhD , Nicholas Jackson MBBS , Gwilym Morris PhD , Bradley Wilsmore PhD\",\"doi\":\"10.1016/j.jacep.2024.05.037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the efficacy and safety of upfront chest pressure during direct current cardioversion for AF with anterior-posterior pad positioning.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = 0.19). There was no difference in first shock success, total shocks provided, average impedance, and cardioversion success.</div></div><div><h3>Conclusions</h3><div>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]; <span><span>ACTRN12620001028998</span><svg><path></path></svg></span>)</div></div>\",\"PeriodicalId\":14573,\"journal\":{\"name\":\"JACC. Clinical electrophysiology\",\"volume\":\"10 10\",\"pages\":\"Pages 2207-2213\"},\"PeriodicalIF\":8.0000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. Clinical electrophysiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2405500X24004870\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Clinical electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405500X24004870","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Manual Chest PRESSURE During Direct Current Cardioversion for Atrial Fibrillation
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
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
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
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
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)
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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