Single vs. Dual-DCCV in Obese Patients

Description

Currently, the usual initial strategy for direct current cardioversion (DCCV) typically involves delivering 200J of electricity between two pads placed in the anterior and posterior positions (i.e., one on the chest and one on the back). However, this technique may be less likely to result in successful cardioversion in obese patients (BMI ≥30 kg/m2). Failure to achieve sinus rhythm then necessitates additional shocks, which still may ultimately fail to terminate the patient's atrial fibrillation, thereby increasing the likelihood of adverse events from multiple cardioversion attempts "Dual-DCCV" is a technique in which four pads are used to deliver two simultaneous shocks of 200J, totaling 400J. Guidelines published by the American Heart Association/American College of Cardiology/Heart Rhythm Society and the European Society of Cardiology provide only general guidance regarding the appropriate technique and energy selection in patients undergoing cardioversion, with no specific recommendations pertaining to dual-DCCV or obese patients. This study aims to assess the safety and efficacy of dual-DCCV as an initial treatment strategy, compared to standard single-DCCV, in the obese population.

Conditions

Atrial Fibrillation

Study Overview

Study Details

Study overview

Currently, the usual initial strategy for direct current cardioversion (DCCV) typically involves delivering 200J of electricity between two pads placed in the anterior and posterior positions (i.e., one on the chest and one on the back). However, this technique may be less likely to result in successful cardioversion in obese patients (BMI ≥30 kg/m2). Failure to achieve sinus rhythm then necessitates additional shocks, which still may ultimately fail to terminate the patient's atrial fibrillation, thereby increasing the likelihood of adverse events from multiple cardioversion attempts "Dual-DCCV" is a technique in which four pads are used to deliver two simultaneous shocks of 200J, totaling 400J. Guidelines published by the American Heart Association/American College of Cardiology/Heart Rhythm Society and the European Society of Cardiology provide only general guidance regarding the appropriate technique and energy selection in patients undergoing cardioversion, with no specific recommendations pertaining to dual-DCCV or obese patients. This study aims to assess the safety and efficacy of dual-DCCV as an initial treatment strategy, compared to standard single-DCCV, in the obese population.

Efficacy and Safety of Dual Direct Current Cardioversion Versus Single Direct Current Cardioversion as an Initial Treatment Strategy in Obese Patients

Single vs. Dual-DCCV in Obese Patients

Condition
Atrial Fibrillation
Intervention / Treatment

-

Contacts and Locations

Gretna

Ochsner Medical Center - West Bank, Gretna, Louisiana, United States, 70056

New Orleans

Ochsner Medical Center, New Orleans, Louisiana, United States, 70121

Shreveport

LSU Health Sciences Center - Shreveport, Shreveport, Louisiana, United States, 71103

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • * 18 years of age
  • * Atrial fibrillation (paroxysmal, persistent, and long-standing persistent)
  • * Obesity (defined as body mass index \[BMI\] ≥35 kg/m2). Of note, our current institutional protocol uses weight \>250 lbs as an indication for dual-DCCV. An average height of 70 inches equates to BMI \~35 kg/m2
  • * Adequate anticoagulation at the time of the cardioversion (one of the following):
  • * Coumadin with an INR \>2
  • * Direct oral anticoagulants (apixaban, dabigatran, rivaroxaban, or edoxaban)
  • * Subcutaneous low molecular-weight heparin or IV unfractionated heparin
  • * If the duration of atrial fibrillation is \>48 hours (or unknown): trans-esophageal echocardiography (TEE) performed prior to cardioversion to document the absence of a left atrial thrombus, or continuous therapeutic anticoagulation for a minimum of 3 weeks prior to cardioversion
  • * Able to maintain uninterrupted therapeutic anticoagulation after cardioversion, for at least one month
  • * Contraindication to cardioversion
  • * Not on adequate anticoagulation
  • * Emergent cardioversion
  • * Incarceration
  • * Pregnancy

Ages Eligible for Study

18 Years to

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

Dr. Daniel P Morin, MD MPH FHRS,

Daniel P Morin, MD, PRINCIPAL_INVESTIGATOR, Ochsner Health System

Study Record Dates

2023-07-31