Abstract 12651: Non-Pharmacological Interventions to Improve Electrical Cardioversion Success in Patients With Atrial Fibrillation: A Scoping Review
Bibliographic record
Abstract
Introduction: Electrical cardioversion is used commonly in patients with atrial fibrillation (AF). However, success rates vary and practical guidance is limited. Methods: We searched CENTRAL, Medline and EMBASE from inception to present and the grey literature. We included randomized controlled trials (RCTs) comparing any two interventions. Outcomes were initial and cumulative cardioversion success. We pooled data using random effects models. Results: From 13481 citations, we included 52 RCTs. Biphasic as compared to monophasic waveforms resulted in a higher rate of cardioversion for initial (18 studies, risk ratio [RR] 1.45, 95% confidence interval [CI] 1.10-1.90, I 2 =89%) and cumulative success (21 studies, RR 1.07, 95% CI 1.02-1.13, I 2 =75%). Fixed, maximum-energy shocks as compared to low-dose escalating energy protocols had a higher likelihood of initial (4 studies, RR 1.62, 95% CI 1.33-1.98, I 2 =72%) but not cumulative success (3 studies, RR 1.13, 95% CI 0.97-1.32, I 2 =86%). Initial or cumulative cardioversion success did not differ significantly for several other interventions. This included: antero-apical/lateral vs. anteroposterior positioned pads (initial: 10 studies, RR 1.06, 95% CI 0.89-1.27; cumulative: 13 studies, RR 0.99, 95% CI 0.95-1.04); rectilinear/pulsed biphasic vs. biphasic truncated exponential waveform (initial: 3 studies, RR 1.07, 95% CI 0.76-1.50; cumulative: 3 studies, RR 0.95, 95% CI 0.80-1.12); cathodal vs. anodal configuration (cumulative: 2 studies, RR 1.03, 95% CI 0.97-1.09); magnesium pre-treatment vs. none (initial: 2 studies, RR 1.36, 95% CI 0.82-2.24; cumulative: 2 studies, RR 1.05, 95% CI 0.96-1.14); and patches vs. manual pressure/paddles (initial: 2 studies, RR 1.04, 95% CI 0.26-4.12; cumulative: 2 studies, RR 0.87, 95% CI 0.61-1.25). Conclusions: Biphasic shock waveforms and high-energy shocks increase the efficacy of cardioversion of AF. Other interventions, including pad placement, biphasic waveform properties, electrode polarity, electrolyte pre-treatment, and manual pressure require further study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.040 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.011 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".