Journal of Cardiovascular Electrophysiology | 2019
RESPONSE TO LETTER TO EDITOR
Abstract
The high cardioversion success rates for atrial fibrillation reported using the Ottawa‐atrial fibrillation (AF) cardioversion protocol coupled with our study’s findings send an important message to physicians: that manual pressure augmentation (MPA) and the use of 360 J defibrillators are alternative techniques rather than accepting “permanent AF” after failed cardioversion using 200 J with adhesive patches (as is standard practice at many centers). Of note, some of the patients in our study were referred for inclusion after failed cardioversion elsewhere, and perhaps this more selected population may explain the higher failure rates with 200 J patches observed in our randomized study compared with the observational results reported by Ramirez et al With respect to the methodology of MPA, this was performed in either the AA or AP configuration (50% each) and a single operator performed this on 75% of occasions. Handheld paddles are not routinely available at many Australian hospitals, and hence it was important to report the MPA technique (using gloves) as a safe and effective technique. In addition, many centers do not have external defibrillators to provide shocks up to 360 J. We have observed in some instances that a second operator applying MPA is required in morbidly obese patients (depending on the body size of the first operator) to achieve cardioversion success.