PT - JOURNAL ARTICLE AU - B M Glover AU - S J Walsh AU - C J McCann AU - M J Moore AU - G Manoharan AU - G W N Dalzell AU - A McAllister AU - B McClements AU - D J McEneaney AU - T G Trouton AU - T P Mathew AU - A A J Adgey TI - Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial AID - 10.1136/hrt.2007.120782 DP - 2008 Jul 01 TA - Heart PG - 884--887 VI - 94 IP - 7 4099 - http://heart.bmj.com/content/94/7/884.short 4100 - http://heart.bmj.com/content/94/7/884.full SO - Heart2008 Jul 01; 94 AB - Aims: To compare the efficacy and safety of an escalating energy protocol with a non-escalating energy protocol using an impedance compensated biphasic defibrillator for direct current cardioversion of atrial fibrillation (AF).Methods and results: This prospective multicentre randomised trial enrolled 380 patients (248 male, mean (SD) age 67 (10) years) with AF. Patients were randomised to either an escalating energy protocol (protocol A: 100 J, 150 J, 200 J, 200 J), or a non-escalating energy protocol (protocol B: 200 J, 200 J, 200 J). Cardioversion was performed using an impedance compensated biphasic waveform. First-shock success was significantly higher for those randomised to 200 J than 100 J (71% vs 48%; p<0.01) and for patients with a body mass index (BMI) >25 kg/m2 (75% vs 44%; pā€Š=ā€Š0.01). In patients with a normal BMI there was no significant difference in first-shock success. There was also no significant difference between subsequent shocks or overall success. The use of a non-escalating protocol (protocol B) resulted in fewer shocks but with a higher cumulative energy. There was no difference in duration of procedure, amount of sedation administered or post-shock erythema between the groups.Conclusion: First-shock success was significantly higher, particularly in patients with a BMI >25 kg/m2, when a non-escalating initial 200 J energy was selected. The overall success, duration of procedure and amount of sedation administered, however, did not differ significantly between the two protocols.