Determination of Pad Placement With Cine Fluoroscopy Guidance on Cardioversion Success
Journal of the American College of Cardiology
Background: Anterior-posterior (AP) electrode placement is considered the optimal position for electrical cardioversion (EC) of atrial fibrillation (AF). We sought to investigate the impact of patch placement relative to the cardiac border on cardioversion efficacy. Methods: Over 3 months, we included AF patients undergoing standard of care EC using a biphasic AED. Patches were placed in AP position and Manual Pressure Augmentation (MPA) was performed in all cases. Cine images were used to measure the distances from: Anterior (A), mid-point between both electrodes (B), and posterior electrode (C) to mid-point of cardiac silhouette (Figure 1A,B). Patients were grouped according to number of shocks needed (1 vs >1) and energy used (100J vs >100J). Distances are reported as mean (SD) and T-test was performed for comparison. Results: Of the 40 patients included, success rate was 100%. The anterior and mid-point patch placement distance was lower in patients who required only 1 shock compared to those who required >1 (5.2cm vs 8.2, p=0.02 and 5.6cm vs 8.9, p=0.01, respectively). Posterior patch placement did not significantly differ (p=0.11). Similar findings were noted in patients who had successful EC with only 100J vs those who needed >100J shock delivery. (Figure 1C,D)Conclusion: In routine AP placement, patch placement relative to cardiac silhouette appears to affect the success of cardioversion. In a sub-set of patient population, image-guided patch placement may add value to improve outcomes.
France J, Madanat L, Shoukri N, Kutinsky IB, Gundlapalli S, Walsh DG, et al. [Bilolikar A, Goel AK, Williamson BD, Gallagher MJ, Bloomingdale R, Haines DE, Mehta N]. Determination of pad placement with cine fluoroscopy guidance on cardioversion success. J Am Coll Cardiol. 2023 Mar;81(8 Suppl.A):219. doi:10.1016/S0735-1097(23)00663-0