When I cardiovert AF, I use the highest energy possible energy in the first cardioversion attempt. I consider this to be a resistant arrhythmia and want to have the best chance of cardioversion. Is this what everyone else does? Do you escalate doses? What does the evidence show?…….Enter the BEST AF Trial(1).
What They Did
This was a Prospective, Multicentre randomised trial, using biphasic defibrillation.
In. this trial patients had persistent atrial fibrillation, or were referred for cardioversion.
This is not the group of patients with new onset AF we usually see in the Emergency Department.
Patients were randomised into 2 groups:
- Escalating Energy: 100J, 150J, 200J, 200J or
- Non-escalating: 200J, 200J, 200J.
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