Demographic Determination of Low Energy Cardioversion Success (100J) in Patients With Atrial Fibrillation

Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of the American College of Cardiology


Background: Electrical cardioversion (EC) of atrial fibrillation (AF) is considered a cornerstone in restoring normal sinus rhythm. The use of higher energy and increased number of shocks is associated with adverse events. We sought to describe the effectiveness of low energy EC and investigate demographic factors associated with failure. Methods: We included consecutive patients with AF presenting for routine EC. All patients underwent a stepwise approach of EC with a biphasic AED starting with 100J >200J >360J. Failure of all 3 shocks was considered EC failure. Patients were grouped into Group A: successful EC with 1 shock of 100J and Group B: failed EC with 100J shock requiring energy escalation. Logistic regression was used to test for association. Results: Of the 37 patients enrolled, 100% had overall successful EC, of which 25 (67.6%) comprised Group A. Patients in Group B were more likely to have BMI >30 compared to Group A (75% vs 36%, P=0.03). Age (OR: 0.97, P=0.3), gender (Male: OR 0.5, P=0.3) and height (OR 1.03, P=0.4) did not significantly affect energy required. On multivariate analysis accounting for age and gender, higher body surface area (BSA) and BMI were associated with increased failure of 100J shock (OR: 1.2, 95% CI:1.03-1.14, P=0.01 and OR: 1.2, 95% CI:1.03-1.4, P=0.04, respectively). Figure Conclusion: The use of 100J as a starting point for EC of AF is successful and could be recommended as first line. However in patients who are obese or have large BSA, escalation may be required




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American College of Cardiology Annual Scientific Session & Expo with World Congress of Cardiology, March 4-6, 2023, New Orleans, LA.