{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:42:52Z","timestamp":1789580572547,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T00:00:00Z","timestamp":1560211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Dual external direct current cardioversion (dual\u2010DCCV) is a rhythm control strategy for persistent atrial fibrillation (AF), involving simultaneous delivery of two shocks from two defibrillators. The long\u2010term effectiveness of this approach has not been studied in the biphasic cardioversion era.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seventy\u2010seven consecutive patients at a single center were identified to receive dual\u2010DCCV at the time of their initial cardioversion for AF, when maximum output standard external direct current cardioversion failed in two vectors. Logistic regression was used to analyze risk factors for dual\u2010DCCV in a historical control group of 77 patients undergoing standard cardioversion and Cox proportional hazard models were used to compare time to AF recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The dual\u2010DCCV group had a significantly larger body mass index (BMI), but similar AF duration and left atrial size as controls. Multivariable logistic regression revealed that BMI and absence of prior paroxysmal AF were risk factors for dual\u2010DCCV (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). There was no difference observed between dual\u2010DCCV and control groups (adjusted hazard ratio\u2009=\u20090.57; <jats:italic>P<\/jats:italic>\u2009=\u2009.12) after adjusting for number of shocks and age. Transient hypoxia was the only acute complication in either group (<jats:italic>P<\/jats:italic>\u2009&gt;\u2009.999).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dual\u2010DCCV appears to be a safe and effective cardioversion strategy for patients with AF. The need for dual\u2010DCCV in the treatment of AF appears to be influenced more by body habitus than atrial substrate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13994","type":"journal-article","created":{"date-parts":[[2019,5,21]],"date-time":"2019-05-21T07:02:19Z","timestamp":1558422139000},"page":"1636-1643","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effectiveness of dual external direct current cardioversion for initial cardioversion in atrial fibrillation"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5443-5083","authenticated-orcid":false,"given":"Michael W.","family":"Gardner","sequence":"first","affiliation":[{"name":"Knight Cardiovascular Institute, Division of Cardiology Oregon Health &amp; Science University Hospital Portland 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