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Europace Advance Access originally published online on June 2, 2007
Europace 2007 9(10):942-946; doi:10.1093/europace/eum107
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© The European Society of Cardiology 2007. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

MISCELLANEOUS

Predictors of success and effect of biphasic energy on electrical cardioversion in patients with persistent atrial fibrillation

Josep M. Alegret1,*, Xavier Viñolas2, Jaume Sagristá3, Antonio Hernandez-Madrid4, Luisa Pérez5, Xavier Sabaté6, Lluís Mont7, Alfonso Medina on behalf of the REVERSE Study Investigators8

1 Sección de Cardiología, Hospital Universitari de Sant Joan de Reus, c/Sant Joan s/n, 43201 Reus, Spain; 2 Servicio de Cardiología, Hospital de la Santa Creu i St Pau, Barcelona, Spain; 3 Servicio de Cardiología, Hospital Valle de Hebrón, Barcelona, Spain; 4 Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, Spain; 5 Servicio de Cardiología, Hospital Juan Canalejo, La Coruña, Spain; 6 Servicio de Cardiología, Hospital de Bellvitge, Hospitalet de Llobregat, Spain; 7 Servicio de Cardiología, Hospital Clínic, Barcelona, Spain; 8 Servicio de Cardiología, Hospital Dr Negrín, Las Palmas, Spain

Aims We sought predictors of successful electrical cardioversion (ECV) and the effect of biphasic energy in patients considered candidates for rhythm control.

Methods and results The patients were drawn from a registry, which included prospectively 1355 consecutive patients with persistent atrial fibrillation who underwent ECV in 96 Spanish hospitals. Successful ECV was considered excluding patients with an early relapse. Factors related to successful cardioversion were evaluated using logistic regression with the patients segregated with respect to the use of monophasic or biphasic energy. Sinus rhythm was restored in 92% of the patients, of which, 5% had an early relapse. Thus, we considered that a successful ECV was achieved in 87% of patients. Body surface area was the only factor independently related to failure of the monophasic energy cardioversion (OR = 0.20; P = 0.001). No single factor was predictive of biphasic energy cardioversion failure. Biphasic energy was more effective in restoring sinus rhythm in patients with body surface area >2.05 m2 (83% success in monophasic vs. 92% in biphasic; P = 0.02).

Conclusion Body surface area was the only factor related to the success of ECV, but only in patients treated with monophasic energy. Biphasic energy should be the technique-of-choice in patients with a large body surface area.

Key Words: Atrial fibrillation, Electrical cardioversion, Predictors, Biphasic energy

* Corresponding author. Tel: +34 977310300; fax: +34 977319984. E-mail address: txalegret{at}hotmail.com

Manuscript submitted 3 January 2007. Accepted after revision 24 April 2007.


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