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Meta-Analysis
. 2023 Apr;46(4):359-375.
doi: 10.1002/clc.23987. Epub 2023 Feb 9.

Anteriolateral versus anterior-posterior electrodes in external cardioversion of atrial fibrillation: A systematic review and meta-analysis of clinical trials

Karam R Motawea  1 , Mostafa R Mostafa  2 , Merna Aboelenein  1 , Mohamed Magdi  2 , Hager Fathy  3 , Sarya Swed  4 , Mohamed M Belal  1 , Dina M Awad  1 , Rowan H Elhalag  1 , Nesreen E Talat  1 , Samah S Rozan  1 , Abdulqadir J Nashwan  5 , Naim Battikh  6 , Bisher Sawaf  7 , Mhd K Albuni  7 , Elias Battikh  7 , Gihan M Mohamed  7 , Amr Farwati  7 , Hani Aiash  8
Affiliations
Meta-Analysis

Anteriolateral versus anterior-posterior electrodes in external cardioversion of atrial fibrillation: A systematic review and meta-analysis of clinical trials

Karam R Motawea et al. Clin Cardiol. 2023 Apr.

Abstract

The efficacy of anteriolateral versus anterior-posterior electrode positions in the success of atrial fibrillation's (AF) electrical cardioversion is unclear. Our aim is to perform a meta-analysis to compare the success rate of both electrode positions. PUBMED, WOS, OVID, and SCOPUS were searched. Inclusion criteria were clinical trials that compared anterior-lateral with anterior-posterior electrodes in external cardioversion of AF. After the full-text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior-lateral electrode and increased cardioversion rate of AF (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.02-1.92, p = .04). Subgroup analysis revealed a statistically significant association between the anterior-lateral electrode and increased cardioversion rate of AF in subgroups of less than five shocks, patients with 60 years old or more and patients with left atrial (LA) diameter >45 mm (OR = 1.72, 95% CI = 1.17-2.54, p = .006), (OR = 1.73, 95% CI = 1.18-2.54, p = .005), and (OR = 1.86, 95% CI = 1.04-3.34, p = .04), respectively. Anteriolateral electrode is more effective than anterior-posterior electrode in external cardioversion of AF, particularly in patients who have received less than 5 shocks, are 60 years old or older and have a LA diameter greater than 45 mm.

Keywords: anterior-lateral electrode; anterior-posterior electrode; atrial fibrillation; cardioversion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flow diagram.
Figure 2
Figure 2
Risk of bias assessment. NA, not available.
Figure 3
Figure 3
Forest plot of the comparison between the anterior–lateral electrode and anterior–posterior electrode in external cardioversion of atrial fibrillation in the overall analysis. CI, confidence interval; M–H, Mantel–Haenszel.
Figure 4
Figure 4
Publication bias. OR, odds ratio.
Figure 5
Figure 5
Number of shocks subgroup analysis. CI, confidence interval; M–H, Mantel–Haenszel.
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