I just finished a Grand Rounds today for our housestaff and came across this helpful compilation of data on improving the success of cardioversion in humans. To summarize:
- Use anterior-posterior (AP) rather than anterior-anterior (AA) patch position
- Higher energies up front often lead to lower shock requirements to achieve success
- Use biphasic defibrillators over monophasic defibrillators
- If unsuccessful, consider pre-treating the patient with Ibutilide (1 mg over 10-15 min IVPB)
Two other techniques I have used with success are:
- Apply firm anteroposterior pressure to the chest (you can use a disconnected set of paddles). The decrease in AP diameter increased the energy delivered to the heart.
- A two defibrillator setup. Two defibrillators, two sets of pads in the AP location. Helps if the HR is slowed with an AV nodal blocker. You push both shock buttons simultaneously. Doubles the energy delivery to the heart.
Not surprisingly, I have only used these approaches in very obese people.
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