{"id":"f7de9d2018b8","type":"article","url":"https://hartvaat.nl/2024/07/01/dubbele-versus-enkele-cardioversie-bij-af-en-obesitas-jama-cardiology-rct/","title":"Dubbele versus enkele cardioversie bij AF en obesitas: JAMA Cardiology RCT","title_en":"Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity: A Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["obesitas"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.1091","source_url":"https://doi.org/10.1001/jamacardio.2024.1091","authors":["Joshua D Aymond","Alexandra M Sanchez","Michael R Castine","Michael L Bernard","Sammy Khatib","A Elise Hiltbold","Glenn M Polin","Paul A Rogers","Paari S Dominic","Cruz Velasco-Gonzalez","Daniel P Morin"],"significance":7,"published":"2024-07-01","source_date":"2024-07-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized trial showed that dual simultaneous cardioversion using two defibrillators improves success rates for AF termination in obese patients, providing a practical solution for the common problem of cardioversion failure in obesity.","created":"2026-07-03T10:31:00Z","updated":"2026-07-03T13:30:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial toonde dat simultane dubbele cardioversie (twee defibrillatoren) het succespercentage bij AF-patiënten met obesitas significant verhoogt vergeleken met standaard enkele cardioversie.","abstract_original":"IMPORTANCE: Atrial fibrillation and obesity are common, and both are increasing in prevalence. Obesity is associated with failure of cardioversion of atrial fibrillation using a standard single set of defibrillator pads, even at high output. OBJECTIVE: To compare the efficacy and safety of dual direct-current cardioversion (DCCV) using 2 sets of pads, with each pair simultaneously delivering 200 J, with traditional single 200-J DCCV using 1 set of pads in patients with obesity and atrial fibrillation. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, investigator-initiated, patient-blinded, randomized clinical trial spanning 3 years from August 2020 to 2023. As a multicenter trial, the setting included 3 sites in Louisiana. Eligibility criteria included body mass index (BMI) of 35 or higher (calculated as weight in kilograms divided by height in meters squared), age 18 years or older, and planned nonemergent electrical cardioversion for atrial fibrillation. Patients who met inclusion criteria were randomized 1:1. Exclusions occurred due to spontaneous cardioversion, instability, thrombus, or BMI below threshold. INTERVENTIONS: Dual DCCV vs single DCCV. MAIN OUTCOMES AND MEASURES: Return to sinus rhythm, regardless of duration, immediately after the first cardioversion attempt of atrial fibrillation, adverse cardiovascular events, and chest discomfort after the procedure. RESULTS: Of 2079 sequential patients undergoing cardioversion, 276 met inclusion criteria and were approached for participation. Of these, 210 participants were randomized 1:1. After exclusions, 200 patients (median [IQR] age, 67.6 [60.1-72.4] years; 127 male [63.5%]) completed the study. The mean (SD) BMI was 41.2 (6.5). Cardioversion was successful more often with dual DCCV compared with single DCCV (97 of 99 patients [98%] vs 87 of 101 patients [86%]; P = .002). Dual cardioversion predicted success (odds ratio, 6.7; 95% CI, 3.3-13.6; P = .01). Patients in the single cardioversion cohort whose first attempt failed underwent dual cardioversion with all subsequent attempts (up to 3 total), all of which were successful: 12 of 14 after second cardioversion and 2 of 14 after third cardioversion. There was no difference in the rating of postprocedure chest discomfort (median in both groups = 0 of 10; P = .40). There were no cardiovascular complications. CONCLUSIONS AND RELEVANCE: In patients with obesity (BMI ≥35) undergoing electrical cardioversion for atrial fibrillation, dual DCCV results in greater cardioversion success compared with single DCCV, without any increase in complications or patient discomfort. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04539158."}