Anterior-Lateral or Anterior-Posterior Pads for A-fib Cardioversion?

Written by Cliff Freeman

Spoon Feed
Anterior-lateral positioning is superior to anterior-posterior electrode positioning in biphasic cardioversion of atrial fibrillation.

Why does this matter?
We see atrial fibrillation often, and cardioversion is a pillar of its treatment. Which is better, anterior-lateral or anterior-posterior electrode placement?

It’s a game of inches
This was a randomized, open label trial comparing anterior-lateral to anterior-posterior electrode positioning in 468 patients undergoing elective cardioversion for atrial fibrillation. This has previously been studied, but not sufficiently with biphasic cardioversion. The authors found that after the first shock, 54% of patients in the anterior-lateral group vs 33% of patients in the anterior-posterior group converted to sinus rhythm (95% CI, 13-30; P<0.001). This difference was more pronounced in obese patients and patients with their first episode of atrial fibrillation. There was no difference in safety outcomes.

From cited article. Go with pad placement A above.

Source
Anterior-Lateral Versus Anterior-Posterior Electrode Position for Cardioverting Atrial Fibrillation. Circulation. 2021 Dec 21;144(25):1995-2003. doi: 10.1161/CIRCULATIONAHA.121.056301. Epub 2021 Nov 24.

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