Arrhythmias & electrophysiology
Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity: A Randomized Clinical Trial
Authors' conclusion
In patients with obesity (BMI ≥35) undergoing electrical cardioversion for atrial fibrillation, dual DCCV results in greater cardioversion success compared with single DCCV, without any increase in complications or patient discomfort.
Study context
- Population
- Patients with obesity (body mass index (BMI) ≥35) and AF undergoing planned nonemergent electrical cardioversion200 completed
- Participants
- 210 patients
- Comparison
- Dual direct-current cardioversion (DCCV) vs single DCCV
- Dual DCCVn = 99
- Single DCCVn = 101reference
- Primary endpoint
- Return to sinus rhythm, regardless of duration, immediately after the first cardioversion attempt
- Follow-up
- Immediately after the first cardioversion attempt
Methodological detailsinvestigator-initiated, patient-blinded, multicentre, 3 sites in Louisiana
- Investigator-initiated
- Patient-blinded
- Multicentre
- 3 sites in Louisiana
Primary result
As reported in the abstract
Return to sinus rhythm immediately after first cardioversion attempt
P = 0.002
- Dual cardioversion predicted success (OR 6.7, 95% CI 3.3-13.6)
- P = 0.01
Further findings
Success of subsequent dual cardioversion after failed first single attempt
- All successful: after second cardioversion
- 12 of 14
- After third cardioversion
- 2 of 14
Safety
| Outcome | Dual DCCV | Single DCCV | P value |
|---|---|---|---|
| Postprocedure chest discomfort rating · no difference | median 0 of 10 | median 0 of 10 | P = 0.40 |
CV complications
- No CV complications
Original publication
Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity: A Randomized Clinical Trial. JAMA Cardiol. Published 1 July 2024. doi:10.
Summarised from the published abstract; every number is checked against it