Table 2
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study weaknesses |
|---|---|---|---|---|---|
| Mathew TP et al, 1999, UK | 90 patients | Prospective, randomised | Cardioversion success rate | 38/45 success for AL v 33/45 for AP p = 0.42. | No power |
| Elective | Mean (SD) energy used | 223 (96.1) J for AL v 232 (110) J for AP | Randomisation method not explicit | ||
| Antero-lateral (AL) v Antero-posterior (AP) | Mean (SD) thoracic impedance on first shock | 77.5 (18.4) Ohms AL v 73.7 (18.7) Ohms AP p = 0.34 | Elective patients | ||
| 100J then 200J, 300J, 360J | |||||
| Botto GL et al, 1999, Italy | 301 patients with stable AF | Prospective randomised controlled trial | Success rate at initial 3J/kg shock | 87/151 success for AL v 100/150 for AP. | No power calculation |
| AL v AP | Cumulative success rate after first 4J/kg shock | 114/151 for AL v 131/150 for AP (p = 0.013) | Randomisation method not explicit | ||
| 3J/kg then 4J/kg then 4J/kg in alternative position | Cumulative success after second 4J/kg shock | 140/150 for AL v 140/150 for AP p = NS | All elective with chronic AF | ||
| Alp NJ et al, 2000, UK | 59 patients with persistent AF | RCT cross-over | Cardioversion success rate on first 360J DC shock. | With first 360J AL more successful 18/30 v10/29 for AP (p = 0.048). | Small numbers |
| AP v AL (360 J) | Cardioversion second 360J shock | 4/19 for AL v 5/12 for AP p = 0.22 | Elective | ||
| Patients with persistent AF | |||||
| Kirchhof P et al, 2002, Germany | 108 patients with persistent AF | RCT cross-over (if no response in initial paddle position at 360J) | Cardioversion success rate in initial paddle positions | 50/52 for AP v 44/56 for AL p = 0.009. | Elective patients with persistent AF |
| Elective cardioversion (50–360J) AP v AL | Cardioversion if initial position failed | 8/12 cardioverted when crossed from AL to AP. No success in those AP to AL (2 patients) | |||
| Chen CJ and Guo GB, 2003, Japan | 70 patients with persistent AF (>1 month). | Randomised controlled trial | Cardioversion success at 100J | AP v AL 23% v19.4% p = NS | Small, low powered study |
| AL (31 patients) v AP (39 patients) | Cumulative cardioversion success at 150J | AP v AL 41% v 45.2% p = NS | Only looks at those with persistent AF in an elective setting (excluded those with new onset AF, one month) | ||
| Step up protocol 100, 150, 200, 300, 360 joules | Cumulative cardioversion success at 200J | AP v AL 66.7% v 74.2% p = NS | No randomisation details | ||
| Cumulative cardioversion success at 300J | AP v AL 79.5% v 77.4% p = NS | ||||
| Cumulative cardioversion success at 360J | AP v AL 84.6% v 83.9% p = NS |
