ANTEROPOSTERIOR PADDLE PLACEMENT IS SUPERIOR TO ANTEROLATERAL PADDLE PLACEMENT FOR CARDIOVERSION OF ATRIAL FIBRILLATION.
L.Parsons*, R. Everingham, L. Savage, N. Bull, Dr. J. Leitch.
Coronary Care Unit, John Hunter Hospital, Newcastle, NSW.
AIM: Placing defibrillation paddles in the anteroposterior (A/P) position may improve cardioversion efficacy. The aim of this study was to compare A/P paddle placement with the anterolateral (A/ L) position for cardioversion of atrial fibrillation (AF).
METHOD: Patients booked for elective cardioversion were invited to participate in the trial and randomly allocated. to either A/P or A/L groups. Joule selection sequence for both modes of paddle placement was 50,100,200,300,360. Defibrillation threshold (DFT) was defined as the energy of successful cardioversion.
RESULTS: There were 31 patients in each group. 18 males and 13 females in the A/ P group (mean age 66 ± 2.4), and 22 males and 9 females in the A/ L group (mean age 65 ± 2.0). There was a significantly lower DFT for the A/ P group (median = 200j interquantile range [IQ] = 100-300), than in the A/ L group (median = 300j, [IQ] = 200-300), (U = 317, p < 0.05). The other factors that were associated with a higher DFT were longer tirne in AF (rho = 0.414, p < 0.01), and higher patient weight ( rho = 0.287, p < 0.004). There were 3 unsuccessful reversions, 1 in the A/ P group and 2 in the A/ L group.
CONCLUSION: Placement of paddles in the A/P position improved cardioversion efficacy.
