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		Mean (SD) thoracic impedance on first shock	77.5 (18.4) Ohms AL v 73.7 (18.7) Ohms AP p = 0.34

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
	AP v AL (360 J)		Cardioversion second 360J shock	4/19 for AL v 5/12 for AP p = 0.22	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
Kirchhof P et al, 2002, Germany	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)	Elective patients with persistent AF

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