“Solely 2% of overweight sufferers failed their first cardioversion try with the twin strategy, in contrast with 14% handled with a typical single direct present cardioversion,” the researchers reported. The findings have been introduced on the American Coronary heart Affiliation (AHA) Annual Assembly, Scientific Session 2023, by Joshua D. Aymond, MD, of Ochsner Well being in New Orleans.

After multivariate evaluation – controlling for gender, age, BMI, left ventricular ejection fraction, left atrial quantity index, obstructive sleep apnea, congestive coronary heart failure and antiarrhythmic drug use – the chance of cardioversion failure was 12.6 occasions increased with single DCCV.

Exterior direct present cardioversion is a mainstay remedy to revive sinus rhythm in AF sufferers. Nonetheless, a good portion of the overweight inhabitants fails conventional cardioversion strategies utilizing a single set of defibrillator electrodes. Failure will increase the chance of uncomfortable side effects related to a number of shocks and lack of cardiac advantages from restoring sinus rhythm.

There’s a lack of different remedy methods. Twin-DCCV, wherein simultaneous shocks are delivered by means of two units of defibrillation electrodes, is a doubtlessly more practical strategy. Subsequently, the analysis crew aimed to evaluate the security and efficacy of dual-DCCV in comparison with single-DCCV in overweight sufferers with atrial fibrillation in a multicenter, randomized, managed trial.

The examine included sufferers with weight problems (BMI ≥35 kg/m2) and atrial fibrillation who underwent elective DCCV. 200 sufferers (65.5 ± 10.7 years, 37% ladies) have been blinded and randomized 1:1 to single DCCV or double DCCV. No matter remedy task, two pairs of electrode patches have been positioned on all members.

The only DCCV group obtained a 200 J shock utilizing solely the first electrode pair. The twin-DCCV group obtained synchronized shocks utilizing each the first and secondary electrode pairs, totaling 400 J. In each teams, failure of the primary cardioversion was adopted by as much as 2 extra dual-DCCV makes an attempt.

The first endpoint of the examine was decided as profitable cardioversion to sinus rhythm instantly after the primary DDCV. Secondary security outcomes have been monitored.

The analysis revealed the next findings:

• Cardioversion failed extra typically with single-DCCV in comparison with dual-DCCV (14% vs. 2%).
• Twin-DCCV predicted profitable cardioversion (OR 16.7), even after backward stepwise correction, beginning with all variables for which.
• After an preliminary failed single DCCV, subsequent shocks (all double) have been profitable in all sufferers: 12/14 after the second DCCV and a pair of/14 after the third DCCV.
• There was no distinction within the evaluation of chest discomfort after the process (median in each teams = 0/10). There have been no problems.

“Twin-DCCV leads to increased cardioversion success in contrast with standard single-DCCV, with none improve in problems in overweight sufferers with atrial fibrillation present process DCCV,” the researchers concluded.

Reference:

Aymond J, et al. “Efficacy and security of twin direct present cardioversion versus single direct present cardioversion as an preliminary remedy technique in overweight sufferers with atrial fibrillation” AHA 2023.