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      Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter

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          Abstract

          Background

          The relevance of transthoracic impedance (TTI) to electrical cardioversion (ECV) success for atrial tachyarrhythmias when using biphasic waveform defibrillators is unknown.

          Hypothesis

          TTI is predictive of ECV success with contemporary defibrillators.

          Methods

          De‐identified data stored in biphasic defibrillator memory cards from ECV attempts for atrial fibrillation (AF) or atrial flutter (AFL) over a 2‐year period at our center were evaluated. ECV success, defined as arrhythmia termination and ≥ 1 sinus beat, was adjudicated by 2 blinded cardiac electrophysiologists. The association between TTI and ECV success was assessed via Cochrane‐Armitage trend and Spearman rank correlation tests, as well as simple and multivariable logistic regression. The influence of TTI on the number of shocks and on cumulative energy delivered per patient was also examined.

          Results

          703 patients (593 with AF, 110 with AFL) receiving 1055 shocks were included. Last shock success was achieved in 88.0% and 98.2% of patients with AF and AFL, respectively. In patients with AF, TTI was positively associated with last shock failure ( P trend =0.019), the need for multiple shocks ( P trend <0.001), and cumulative energy delivered (ρ = 0.348; P < 0.001). After adjusting for first shock energy, 10‐Ω increments in TTI were associated with odds ratios of 1.36 (95% CI: 1.24–1.49) and 1.22 (95% CI: 1.09–1.37) for first and last shock failure, respectively ( P < 0.001 for both).

          Conclusions

          Although contemporary defibrillators are designed to compensate for TTI, this variable continues to be associated with ECV failure in patients with AF. Strategies to lower TTI during ECV for AF may improve procedural success.

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          Author and article information

          Contributors
          msadek@ottawaheart.ca
          Journal
          Clin Cardiol
          Clin Cardiol
          10.1002/(ISSN)1932-8737
          CLC
          Clinical Cardiology
          Wiley Periodicals, Inc. (New York )
          0160-9289
          1932-8737
          11 May 2018
          May 2018
          : 41
          : 5 ( doiID: 10.1002/clc.2018.41.issue-5 )
          : 666-670
          Affiliations
          [ 1 ] Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
          [ 2 ] Biomedical Engineering University of Ottawa Heart Institute Ottawa Ontario Canada
          [ 3 ] School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
          Author notes
          [* ] Correspondence

          Mouhannad M. Sadek, MD, University of Ottawa Heart Institute, 40 Ruskin Street, H‐1285A, Ottawa, ON, Canada K1Y 4W7

          Email: msadek@ 123456ottawaheart.ca

          Article
          PMC6489922 PMC6489922 6489922 CLC22947
          10.1002/clc.22947
          6489922
          29532491
          © 2018 Wiley Periodicals, Inc.
          Page count
          Figures: 3, Tables: 2, Pages: 5, Words: 3175
          Categories
          Clinical Investigations
          Clinical Investigations
          Custom metadata
          2.0
          clc22947
          May 2018
          Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:30.04.2019

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