• Resuscitation · Mar 2016

    Review Meta Analysis

    Monophasic and Biphasic Shock for Transthoracic Conversion of Atrial Fibrillation: Systematic Review and Network Meta-analysis.

    • José Francisco Secorun Inácio, Michele dos Santos Gomes da Rosa, Julie Shah, Jeferson Rosário, João Ricardo Nickenig Vissoci, André Luiz Langer Manica, and Clarissa Garcia Rodrigues.
    • Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia (ICFUC), Porto Alegre, RS, Brazil; Toth Tecnologia, Porto Alegre, RS, Brazil. Electronic address: francisco@tothtecnologia.com.br.
    • Resuscitation. 2016 Mar 1; 100: 66-75.

    ObjectivesConduct a systematic review of the literature to compare the efficacy of different biphasic and monophasic shock waveforms technologies for transthoracic cardioversion of Atrial Fibrillation (AF).MethodsWe searched PubMed, EMBASE, The Cochrane Library, LILACS and ClinicalTrials.gov databases for randomized clinical trials comparing two or more defibrillation waveforms when performing elective transthoracic cardioversion of AF. The outcomes assessed were 1st shock success, overall success, cumulative energy and number of shocks to restore Normal Sinus Rhythm.ResultsWere included 23 trials involving 3046 patients, 5 biphasic and the monophasic waveform. Direct meta-analysis revealed that Biphasic waveforms have higher chance to achieve cardioversion in the 1st shock (OR: 3.2; 95% CI 2.2-4.7) and after a sequence of attempts (OR:2.4; 95% CI 1.5-3.9), requiring 296 less Joules (95% CI 356-237) and 0.74 less shocks (95%CI 1.03-0.44) when compared to Monophasic. Network meta-analysis showed no significant differences between the Biphasic technologies of PhysioControl ADAPTIV, Philips SMART and ZOLL Rectilinear, in any of the four outcomes.ConclusionThe evidences points to a Biphasic waveform superiority over Monophasic to perform AF cardioversion, supporting current guidelines to use less energy when using a Biphasic defibrillator. It is suggested that the Biphasic defibrillators from PhysioControl ADAPTIV, Philips SMART and ZOLL Rectilinear have similar efficacy and the use of any of them may result in similar chances, energy and number of shocks to achieve successful AF cardioversion.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…