SynthesisOpen heart2023
Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis.
Synthesis in Open heart, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Clinical Practice Guideline: Preventive Measures and Treatment Options for Atrial Fibrillation.Deutsches Arzteblatt international · 2025Guideline
- Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity: A Randomized Clinical Trial.JAMA cardiology · 2024Trial
- Electrical cardioversion for atrial fibrillation: nationwide trends in Denmark, 2010-2022.Open heart · 2026Article
- Observational
- Supplementary case reports to the current German Cardiac Society (DGK) position paper on electrical cardioversion : Cardioversion-resistant atrial fibrillation in obese patients: a therapeutic dead-end? Synchronized cardioversion-induced ventricular fibrillation: an uncommon complication.Herzschrittmachertherapie & Elektrophysiologie · 2025Article
- [Electrocardioversion of atrial fibrillation: executive summary of the German Cardiac Society position paper].Herzschrittmachertherapie & Elektrophysiologie · 2025Review
- Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest.JAMA network open · 2024Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveElectrode patch position may not be critical for success when cardioverting atrial fibrillation (AF), but the relevance of applied electrical energy is unclarified. Our objective was to perform a meta-analysis of randomised trials to examine the dose-response relation between energy level and cardioversion success by electrode position in elective cardioversion.
methodsWe searched PubMed, Embase, The Cochrane Library, Google Scholar and Scopus Citations. Inclusion criteria were randomised controlled trials using biphasic shock waves and self-adhesive patches, and publication date from 2000 to 2023. We used random-effects dose-response models to meta-analyse the relation between energy level and cardioversion success by anterolateral and anteroposterior position. Random-effects models estimated pooled risk ratios (RR) for cardioversion success after the first and the final shocks between the two electrode positions.
resultsWe included five randomised controlled trials (N=1078). After the first low-energy shock, the electrode position was not significantly associated with the likelihood of successful cardioversion (pooled RR anterolateral vs anteroposterior placement 1.28, 95% CI 0.93 to 1.76, with considerable heterogeneity). After a high-energy final shock, there was no evidence of an association between the electrode position and the cumulative chance of cardioversion success (pooled RR anterolateral vs anteroposterior 1.05, 95% CI 0.97 to 1.14). Regardless of electrode position, cardioversion success was significantly less likely with shock energy levels < 200J compared with 200J.
conclusionEvidence from contemporary randomised trials suggests that higher level of electrical energy is associated with higher conversion rate when cardioverting AF with a biphasic shockwave. Positioning of electrodes can be based on convenience.
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Registered trials
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.