Evidence map›Paper›PMID 36503970›Full record

SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023

Techniques improving electrical cardioversion success for patients with atrial fibrillation: a systematic review and meta-analysis.

Stephanie T Nguyen, Emilie P Belley-Côté, Omar Ibrahim, Kevin J Um, Alexandra Lengyel, Taranah Adli, Yuan Qiu, Michael Wong, Serena Sibilio, Alexander P Benz and 6 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Guideline
  2. Active Compression During External Cardioversion of Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2025
    Pooled it
  3. Pooled it
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  17. Length of hospital stay for elective electrophysiological procedures: a survey from the European Heart Rhythm Association.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Stephanie T NguyenMichael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0003-0377-7205
Emilie P Belley-CôtéDepartment of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0002-5071-076X
Omar IbrahimDepartment of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0001-7095-182X
Kevin J UmDepartment of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0003-3462-9061
Alexandra LengyelMichael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.
Taranah AdliSchulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5C1, Canada.ORCID 0000-0001-8125-6873
Yuan QiuMichael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0002-9572-9106
Michael WongMichael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.
Serena SibilioIstituto Clinico Sant'Ambrogio, Università di Milano, Milano 20157, Italy.ORCID 0000-0001-7614-8800
Alexander P BenzDepartment of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University, Mainz 55131, Germany.ORCID 0000-0003-2555-1266
Alex WolfUniversity of Limerick School of Medicine, Limerick V94 T9PX, Ireland.
Nicola J WhitlockBishop Tonnos Catholic Secondary School, Ancaster, Ontario L9G 5E3, Canada.ORCID 0000-0002-8738-5745
Juan Gabriel AcostaDepartment of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0002-6439-1085
Jeff S HealeyDepartment of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0003-1216-7580
Adrian BaranchukQueen's University School of Medicine, Queen's University, Kingston, Ontario K7L 3L4, Canada.ORCID 0000-0002-3042-6569
William F McIntyreDepartment of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada.ORCID 0000-0001-6082-7542

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsElectrical cardioversion is commonly used to restore sinus rhythm in patients with atrial fibrillation (AF), but procedural technique and clinical success vary. We sought to identify techniques associated with electrical cardioversion success for AF patients. METHODS AND

resultsWe searched MEDLINE, EMBASE, CENTRAL, and the grey literature from inception to October 2022. We abstracted data on initial and cumulative cardioversion success. We pooled data using random-effects models. From 15 207 citations, we identified 45 randomized trials and 16 observational studies. In randomized trials, biphasic when compared with monophasic waveforms resulted in higher rates of initial [16 trials, risk ratio (RR) 1.71, 95% CI 1.29-2.28] and cumulative success (18 trials, RR 1.10, 95% CI 1.04-1.16). Fixed, high-energy (≥200 J) shocks when compared with escalating energy resulted in a higher rate of initial success (four trials, RR 1.62, 95% CI 1.33-1.98). Manual pressure when compared with no pressure resulted in higher rates of initial (two trials, RR 2.19, 95% CI 1.21-3.95) and cumulative success (two trials, RR 1.19, 95% CI 1.06-1.34). Cardioversion success did not differ significantly for other interventions, including: antero-apical/lateral vs. antero-posterior positioned pads (initial: 11 trials, RR 1.16, 95% CI 0.97-1.39; cumulative: 14 trials, RR 1.01, 95% CI 0.96-1.06); rectilinear/pulsed biphasic vs. biphasic truncated exponential waveform (initial: four trials, RR 1.11, 95% CI 0.91-1.34; cumulative: four trials, RR 0.98, 95% CI 0.89-1.08) and cathodal vs. anodal configuration (cumulative: two trials, RR 0.99, 95% CI 0.92-1.07).

conclusionsBiphasic waveforms, high-energy shocks, and manual pressure increase the success of electrical cardioversion for AF. Other interventions, especially pad positioning, require further study.

Indexed as

Atrial FibrillationElectric CountershockElectrodesHumansTreatment OutcomeAtrial fibrillationCardioversion techniquesElectrical cardioversionNon-pharmacological interventionsSinus rhythm restorationSystematic review

Identifiers

PMID36503970
PMCPMC9935008

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.