Dual direct-current cardioversion improves atrial fibrillation conversion rates in obesity

In patients with obesity undergoing electrical cardioversion for atrial fibrillation (AF), dual direct-current cardioversion (DCCV) appears to be more effective at converting AF into sinus rhythm compared with single DCCV, as reported in a study.

The study included 210 adults with BMI of at least 35 kg/m² and planned nonemergent electrical cardioversion for AF. These participants were randomly assigned to undergo dual DCCV using two sets of pads (n=99), with each pair simultaneously delivering 200 J, or traditional single 200-J DCCV using one set of pads (n=101).

The main outcome was return to sinus rhythm, regardless of duration, immediately after the first cardioversion attempt of AF. Adverse cardiovascular events and chest discomfort after the procedure were also evaluated.

Baseline characteristics were well balanced between the two groups, except for age, with the single DCCV group being more likely to be older than the dual DCCV group (median age 68.8 vs 66.6 years; p=0.003). A total of 200 patients (median age 67.6 years, 63.5 percent male, median BMI 41.2 kg/m²) completed the study.

Compared with single DCCV, dual DCCV resulted in significantly higher cardioversion rates (98 percent vs 86 percent; p=0.002). Dual cardioversion strongly predicted successful cardioversion (odds ratio, 6.7, 95 percent confidence interval [CI], 3.3–13.6; p=0.01).

Participants who initially underwent single DCCV and were not able to achieve successful return to sinus rhythm subsequently underwent dual DCCV, with all subsequent dual DCCV attempts (up to 3 total) resulting in successful cardioversion (86 percent after the second shock and 14 percent after the third shock).

The median rating of postprocedure chest discomfort was 0 in both groups. None of the participants had cardiovascular complications.