HIGHER likelihood of cardioversion success, without increased risk of adverse events, when dual direct-current cardioversion (DCCV) is performed in patients with atrial fibrillation and obesity, according to a recent study. Atrial fibrillation and obesity are increasingly prevalent, with obesity often associated with failure of cardioversion of atrial fibrillation when a single DCCV is used. This study compared the efficacy and safety of dual DCCV, with traditional single DCCV in patients with obesity.
The researchers conducted a prospective, randomized clinical trial across three centres in Louisiana between 2020 and 2023. The multi-centre, patient-blinded trial included 200 patients aged 18 or older with obesity (BMI ≥35) scheduled for nonemergent electrical cardioversion. The mean BMI in the group of participants was 41.2. The research team measured the return to sinus rhythm after the first cardioversion attempt of atrial fibrillation, the number of adverse cardiovascular events and ratings of chest discomfort after the procedure.
Results demonstrated that dual DCCV had a higher success rate (98% versus 86%; p=0.002). Patients initially treated with single DCCV who failed to achieve sinus rhythm were successfully converted using dual DCCV in subsequent attempts. Both groups reported similar ratings of post-procedure chest discomfort (median in both groups was 0 out of 10; p=0.40), and no cardiovascular complications were observed.
In conclusion, dual DCCV significantly improves cardioversion success in patients with obesity over 18 years, without increasing complications or discomfort. These results suggest a potential new standard for treating atrial fibrillation in this population. Beyond patients with obesity, this study highlights the importance of tailoring cardioversion techniques to patient characteristics, potentially leading to more effective and reliable treatment protocols in clinical practice.
Reference
Aymond JD et al. Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity A Randomized Clinical Trial. JAMA Cardiol. 2024;DOI:10.1001/jamacardio.2024.1091
