{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:59:52Z","timestamp":1786373992922,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"6p1","license":[{"start":{"date-parts":[[2004,5,25]],"date-time":"2004-05-25T00:00:00Z","timestamp":1085443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2004,6]]},"abstract":"<jats:p> <jats:italic>Although electrical cardioversion of atrial fibrillation (AF) is frequently performed, initial energy requirements for cardioversion of persistent AF is still a matter of debate. The aim of the study was to determine the efficacy of biphasic shocks for transthoracic cardioversion of persistent AF and to predict adequate initial energy. A prospective study enrolled 94 consecutive patients with persistent AF, who were referred for elective cardioversion with a biphasic waveform. The paddles were placed in the anterolateral position. A step\u2010up protocol was used to estimate the cardioversion threshold. The initial shock energy was 50 J, with subsequent increments to 100, 200, and 300 J in the event of cardioversion failure. The mean age of the study group was of about 65 years (6 \u00b1 11 years) and a median duration of AF was 65 days (3\u2013324). Sixty\u2010two out of 94 patients were men, 55% of the study population was classified as having well\u2010controlled hypertension. The overall success rate of cardioversion was 89%, with a mean 2.2 \u00b1 1.4 shocks, and effective J 217.8 \u00b1 113 delivered during repeated cardioversions. The success rate of low energy shocks: 50 and 50 +100 J was 51%. By logistic regression analysis the only independent predictor of success at low energy shock was shorter duration of AF (r =\u22120.51; P = 0.02). Patients with shorter duration of AF have a higher probability for successful cardioversion with low energy. In patients with longer AF duration, a 200 J shock should be considered for cardioversion as the initial energy. (PACE 2004; 27[Pt. 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