RESUMO
OBJECTIVES: Conduct a systematic review of the literature to compare the efficacy of different biphasic and monophasic shock waveforms technologies for transthoracic cardioversion of Atrial Fibrillation (AF). METHODS: We searched PubMed, EMBASE, The Cochrane Library, LILACS and ClinicalTrials.gov databases for randomized clinical trials comparing two or more defibrillation waveforms when performing elective transthoracic cardioversion of AF. The outcomes assessed were 1st shock success, overall success, cumulative energy and number of shocks to restore Normal Sinus Rhythm. RESULTS: Were included 23 trials involving 3046 patients, 5 biphasic and the monophasic waveform. Direct meta-analysis revealed that Biphasic waveforms have higher chance to achieve cardioversion in the 1st shock (OR: 3.2; 95% CI 2.2-4.7) and after a sequence of attempts (OR:2.4; 95% CI 1.5-3.9), requiring 296 less Joules (95% CI 356-237) and 0.74 less shocks (95%CI 1.03-0.44) when compared to Monophasic. Network meta-analysis showed no significant differences between the Biphasic technologies of PhysioControl ADAPTIV, Philips SMART and ZOLL Rectilinear, in any of the four outcomes. CONCLUSION: The evidences points to a Biphasic waveform superiority over Monophasic to perform AF cardioversion, supporting current guidelines to use less energy when using a Biphasic defibrillator. It is suggested that the Biphasic defibrillators from PhysioControl ADAPTIV, Philips SMART and ZOLL Rectilinear have similar efficacy and the use of any of them may result in similar chances, energy and number of shocks to achieve successful AF cardioversion.
Assuntos
Fibrilação Atrial/terapia , Desfibriladores , Cardioversão Elétrica/métodos , Idoso , Fibrilação Atrial/complicações , Humanos , Pessoa de Meia-Idade , Metanálise em Rede , Resultado do TratamentoRESUMO
Introdução: Historicamente, pacientes com cirurgia de revascularização do miocárdio (CRM) prévia submetidos à intervenção coronária percutânea (ICP) primária têm pior prognóstico que pacientes semCRM prévia. No entanto, análises mais contemporâneas contestam esses achados. Nosso objetivo foi avaliar os desfechos clínicos de 30 dias em pacientes com e sem CRM prévia submetidos à ICP primária. Métodos: Estudo de coorte prospectivo extraído do banco de dados do Instituto de Cardiologia do RioGrande do Sul, contendo 1.854 pacientes submetidos à ICP primária. Resultados: Pacientes com CRM prévia (3,8%) mostraram perfil clínico, em geral, mais grave. O tempo deinício dos sintomas até a chegada ao hospital foi menor nesse grupo (2,50 horas [1,46-3,66] vs. 3,99 horas[1,99-6,50]; p < 0,001) e o tempo porta-balão foi semelhante (1,33 hora [0,85-2,07] vs. 1,16 hora [0,88-1,58];p = 0,12). O acesso femoral foi mais usado no grupo com CRM prévia (91,5% vs. 62,5%; p < 0,001). O uso de tromboaspiração manual foi menor nesse grupo (16,9% vs. 31,1%; p = 0,007), mas não houve diferença no uso de inibidor da glicoproteína IIb/IIIa (28,2% vs. 32,4%; p = 0,28). O sucesso angiográfico foi menor no grupo com CRM prévia (80,3% vs. 93,3%; p = 0,009). Aos 30 dias, pacientes com CRM prévia apresentaram taxas similares de eventos cardíacos adversos maiores (14,1% vs. 11,2%; p = 0,28), e a mortalidade, embora numericamente mais alta, não foi estatisticamente significativa (13,2% vs. 7,0%; p = 0,07).Conclusões: Nessa análise contemporânea, pacientes com CRM prévia submetidos à ICP primária apresentaram perfil clínico mais grave e menor sucesso angiográfico, porém não mostraram diferenças nos desfechos clínicos em 30 dias.
Background: Historically, patients with prior coronary artery bypass graft (CABG) surgery undergoing primary percutaneous coronary intervention (PCI) have a worse prognosis than patients without prior CABG. However, more contemporary analyses have contested these findings. This studys aim was to evaluate the 30-day clinical outcomes in patients with and without prior CABG submitted to primary PCI. Methods: Prospective cohort study, extracted from the database of Instituto de Cardiologia do Rio Grandedo Sul, containing 1,854 patients undergoing primary PCI. Results: Patients with prior CABG (3.8%) showed, in general, a more severe clinical profile. The time of symptom onset until arrival at the hospital was shorter in this group (2.50 hours [1.46 to 3.66] vs. 3.99 hour [1.99 to 6.50]; p < 0.001), while the door-to-balloon time was similar (1.33 hour [0.85 to 2.07] vs.1.16 hour [0.88 to 1.58]; p = 0.12). Femoral access was more often used in the group with prior CABG(91.5% vs. 62.5%; p < 0.001). Manual thrombus aspiration was less often performed in this group (16.9% vs. 31.1%; p = 0.007), but there was no difference regarding the use of glycoprotein IIb/IIIa inhibitors (28.2% vs. 32.4%, p = 0.28). Angiographic success was lower in the group with prior CABG (80.3% vs. 93.3%; p = 0.009). At 30 days, patients with prior CABG had similar rates of major adverse cardiac events (14.1%vs. 11.2%; p = 0.28), and mortality, although numerically higher, was not statistically significant (13.2%vs. 7.0%, p = 0.07). Conclusions: In this contemporary analysis, patients with prior CABG undergoing primary PCI had amore severe clinical profile and lower angiographic success, but showed no differences regarding 30-day clinical outcomes.
