{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:29Z","timestamp":1787017109175,"version":"build-2736575974"},"reference-count":28,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T00:00:00Z","timestamp":1699488000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,10,26]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Electrode patch position may not be critical for success when cardioverting atrial fibrillation (AF), but the relevance of applied electrical energy is unclarified. Our objective was to perform a meta-analysis of randomised trials to examine the dose\u2013response relation between energy level and cardioversion success by electrode position in elective cardioversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Embase, The Cochrane Library, Google Scholar and Scopus Citations. Inclusion criteria were randomised controlled trials using biphasic shock waves and self-adhesive patches, and publication date from 2000 to 2023. We used random-effects dose-response models to meta-analyse the relation between energy level and cardioversion success by anterolateral and anteroposterior position. Random-effects models estimated pooled risk ratios (RR) for cardioversion success after the first and the final shocks between the two electrode positions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included five randomised controlled trials (N=1078). After the first low-energy shock, the electrode position was not significantly associated with the likelihood of successful cardioversion (pooled RR anterolateral vs anteroposterior placement 1.28, 95%\u2009CI 0.93 to 1.76, with considerable heterogeneity). After a high-energy final shock, there was no evidence of an association between the electrode position and the cumulative chance of cardioversion success (pooled RR anterolateral vs anteroposterior 1.05, 95%\u2009CI 0.97 to 1.14). Regardless of electrode position, cardioversion success was significantly less likely with shock energy levels &lt; 200J compared with 200J.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evidence from contemporary randomised trials suggests that higher level of electrical energy is associated with higher conversion rate when cardioverting AF with a biphasic shockwave. Positioning of electrodes can be based on convenience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002456","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T10:27:57Z","timestamp":1699525677000},"page":"e002456","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Electrical energy by electrode placement for cardioversion of atrial fibrillation: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0558-8483","authenticated-orcid":false,"given":"Nicklas","family":"Vinter","sequence":"first","affiliation":[{"name":"Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"},{"name":"Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikkel Zacharias Bystrup","family":"Holst-Hansen","sequence":"additional","affiliation":[{"name":"Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2787-0271","authenticated-orcid":false,"given":"S\u00f8ren Paaske","family":"Johnsen","sequence":"additional","affiliation":[{"name":"Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"},{"name":"Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9215-9796","authenticated-orcid":false,"given":"Lars","family":"Frost","sequence":"additional","affiliation":[{"name":"Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3028-4900","authenticated-orcid":false,"given":"Ludovic","family":"Trinquart","sequence":"additional","affiliation":[{"name":"Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"},{"name":"Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, USA"},{"name":"Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, 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for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European society of cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2020","journal-title":"Eur Heart J"},{"key":"2025081710003671000_10.2.e002456.4","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/europace\/euaa057","article-title":"Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure","volume":"22","author":"Brandes","year":"2020","journal-title":"Europace"},{"key":"2025081710003671000_10.2.e002456.5","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2020-001297","article-title":"Role for machine learning in sex-specific prediction of successful electrical 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