Discussion The results of this systematic review have the potential to benefit thous and s of patients worldwide as well as healthcare systems and healthcare economy .
Background Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2 % in the western world .
Atrial flutter , another arrhythmia , occurs less often with an incidence of approximately 200,000 new patients per year in the USA .
Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities .
The management of atrial fibrillation and atrial flutter is often based on interventions aim ing at either a rhythm control strategy or a rate control strategy .
The evidence on the comparable effects of these strategies is unclear .
This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter .
Optimization of initial energy for cardioversion of atrial tachyarrhythmias with biphasic shocks.
OBJECTIVE Recommendations for optimal first-shock energies with biphasic waveforms are conflicting . We evaluated prospect ively the relation between type and duration of atrial tachyarrhythmias and the probability of successful cardioversion with a specific biphasic shock waveform to develop recommendations for the initial energy setting aim ing at the lowest total cumulative energy with 2 or less consecutive shocks . METHODS We analyzed 453 consecutive patients undergoing their first transthoracic electrical cardioversion , including 358 attempts for atrial fibrillation ( AF ) and 95 attempts for atrial flutter ( AFL ) or atrial tachycardia ( AT ) . A step-up protocol with a truncated exponential biphasic waveform starting at 50 J was used . Total cumulative energies were estimated under the assumption of a 2-tiered escalating shock protocol with different initial energy setting s and a " rescue shock " of 250 J for AFL/AT or 360 J for AF . The initial energy setting leading to the lowest total cumulative energy was regarded as the optimal first-shock level . RESULTS Cardioversion was successful in 448 patients ( cumulative efficacy , 99 % ) . In patients with AFL/AT , the lowest total cumulative energy was attained with an initial energy setting of 50 J. In patients with AF , lowest values were achieved with an initial energy of 100 J for arrhythmia duration s of 2 days or less and an initial energy of 150 J for arrhythmia duration s of more than 2 days . CONCLUSION We recommend an initial energy setting of 50 J in patients with AFL/AT , of 100 J in patients with AF 2 days or less , and of 150 J with AF more than 2 days
Discussion The results of this systematic review have the potential to benefit thous and s of patients worldwide as well as healthcare systems and healthcare economy .
Background Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2 % in the western world .
Atrial flutter , another arrhythmia , occurs less often with an incidence of approximately 200,000 new patients per year in the USA .
Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities .
The management of atrial fibrillation and atrial flutter is often based on interventions aim ing at either a rhythm control strategy or a rate control strategy .
The evidence on the comparable effects of these strategies is unclear .
This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter .