Stephanie T. Nguyen MD, Emilie P. Belley-Côté MD, PhD, William F. McIntyre MD, PhD
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In contrast to Motawea et al., we found that overall cardioversion success did not differ when comparing AL to AP-positioned pads (Risk ratio: 1.01, 95% CI: 0.96–1.06, <i>p</i> = .70).<span><sup>2</sup></span></p><p>Two principal issues drive the differences between our studies' results. The first issue relates to study selection. Motawea et al. omitted four randomized trials that were included in our meta-analysis, this represents 389 extra participants or 21% more participants.<span><sup>3-6</sup></span> They also erroneously included one prospective observational cohort study (111 participants).<span><sup>7</sup></span> The second issue relates to data appraisal and/or data abstraction. The authors have recorded incorrect values for the trials by Alp et al. and Botto et al.<span><sup>8, 9</sup></span> For these two trials, the authors appear not to have followed the intention to treat principle; some abstracted values represent cross-overs rather than the pad placements to which the patients were initially randomized.</p><p>We, therefore, advise caution when interpreting the study by Motawea et al.; AL pad placement has not been shown to be superior to AP placement. A definitive trial addressing the question is ongoing (NCT05511389).<span><sup>10</sup></span> An additional important limitation of these data not raised by Motawea et al., is that pad placement has rarely been tested in studies where participants were consistently receiving other co-interventions that have been proven effective (i.e., high energy and biphasic shocks). A large randomized controlled trial comparing pad placement in patients with AF with other best practices in place is thus warranted.</p><p>The authors declare no conflict of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24249","citationCount":"0","resultStr":"{\"title\":\"Letter regarding “Anteriolateral versus anterior–posterior electrodes in external cardioversion of atrial fibrillation: A systematic review and meta-analysis of clinical trials”\",\"authors\":\"Stephanie T. Nguyen MD, Emilie P. Belley-Côté MD, PhD, William F. McIntyre MD, PhD\",\"doi\":\"10.1002/clc.24249\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>The optimal electrode pad placement for successful cardioversion of atrial fibrillation (AF) remains unknown. In a systematic review and meta-analysis of 11 trials, Motawea et al. concluded that anterolateral (AL) positioned pads are more effective than anterior-posterior (AP) positioned pads for electrical cardioversion of patients with AF (odds ratio: 1.40, 95% confidence interval [CI]: 1.02–1.92, <i>p</i> = .04).<span><sup>1</sup></span></p><p>We previously reported a systematic review and meta-analysis of randomized controlled trials of techniques to improve cardioversion success. In contrast to Motawea et al., we found that overall cardioversion success did not differ when comparing AL to AP-positioned pads (Risk ratio: 1.01, 95% CI: 0.96–1.06, <i>p</i> = .70).<span><sup>2</sup></span></p><p>Two principal issues drive the differences between our studies' results. The first issue relates to study selection. Motawea et al. omitted four randomized trials that were included in our meta-analysis, this represents 389 extra participants or 21% more participants.<span><sup>3-6</sup></span> They also erroneously included one prospective observational cohort study (111 participants).<span><sup>7</sup></span> The second issue relates to data appraisal and/or data abstraction. The authors have recorded incorrect values for the trials by Alp et al. and Botto et al.<span><sup>8, 9</sup></span> For these two trials, the authors appear not to have followed the intention to treat principle; some abstracted values represent cross-overs rather than the pad placements to which the patients were initially randomized.</p><p>We, therefore, advise caution when interpreting the study by Motawea et al.; AL pad placement has not been shown to be superior to AP placement. A definitive trial addressing the question is ongoing (NCT05511389).<span><sup>10</sup></span> An additional important limitation of these data not raised by Motawea et al., is that pad placement has rarely been tested in studies where participants were consistently receiving other co-interventions that have been proven effective (i.e., high energy and biphasic shocks). 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引用次数: 0
摘要
成功进行心房颤动(房颤)心脏复律的最佳电极垫位置仍然未知。在对 11 项试验进行的系统回顾和荟萃分析中,Motawea 等人得出结论,在对房颤患者进行电心律转复时,前外侧(AL)定位的电极垫比前后(AP)定位的电极垫更有效(几率比:1.40,95% 置信区间 [CI]:1.02-1.92,p = .04)1。与 Motawea 等人不同的是,我们发现 AL 定位垫与 AP 定位垫相比,总体心脏复苏成功率并无差异(风险比:1.01,95% CI:0.96-1.06,p = .70)。第一个问题与研究选择有关。莫塔维亚等人遗漏了四项随机试验,而我们的荟萃分析中包含了这四项试验,这意味着多了 389 名参与者,即多了 21% 的参与者3-6。他们还错误地纳入了一项前瞻性观察队列研究(111 名参与者)7。作者对 Alp 等人和 Botto 等人的试验记录了错误的数值。8, 9 在这两项试验中,作者似乎没有遵循意向治疗原则;一些抽取的数值代表的是交叉转换,而不是患者最初被随机分配的衬垫位置。莫塔维亚等人没有提出这些数据的另一个重要局限性是,在参与者持续接受其他已被证明有效的联合干预(即高能量和双相电击)的研究中,很少对垫置入进行测试。因此,有必要进行一项大型随机对照试验,比较心房颤动患者在接受其他最佳治疗的同时放置心房颤动垫的效果。
Letter regarding “Anteriolateral versus anterior–posterior electrodes in external cardioversion of atrial fibrillation: A systematic review and meta-analysis of clinical trials”
The optimal electrode pad placement for successful cardioversion of atrial fibrillation (AF) remains unknown. In a systematic review and meta-analysis of 11 trials, Motawea et al. concluded that anterolateral (AL) positioned pads are more effective than anterior-posterior (AP) positioned pads for electrical cardioversion of patients with AF (odds ratio: 1.40, 95% confidence interval [CI]: 1.02–1.92, p = .04).1
We previously reported a systematic review and meta-analysis of randomized controlled trials of techniques to improve cardioversion success. In contrast to Motawea et al., we found that overall cardioversion success did not differ when comparing AL to AP-positioned pads (Risk ratio: 1.01, 95% CI: 0.96–1.06, p = .70).2
Two principal issues drive the differences between our studies' results. The first issue relates to study selection. Motawea et al. omitted four randomized trials that were included in our meta-analysis, this represents 389 extra participants or 21% more participants.3-6 They also erroneously included one prospective observational cohort study (111 participants).7 The second issue relates to data appraisal and/or data abstraction. The authors have recorded incorrect values for the trials by Alp et al. and Botto et al.8, 9 For these two trials, the authors appear not to have followed the intention to treat principle; some abstracted values represent cross-overs rather than the pad placements to which the patients were initially randomized.
We, therefore, advise caution when interpreting the study by Motawea et al.; AL pad placement has not been shown to be superior to AP placement. A definitive trial addressing the question is ongoing (NCT05511389).10 An additional important limitation of these data not raised by Motawea et al., is that pad placement has rarely been tested in studies where participants were consistently receiving other co-interventions that have been proven effective (i.e., high energy and biphasic shocks). A large randomized controlled trial comparing pad placement in patients with AF with other best practices in place is thus warranted.
期刊介绍:
Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery.
The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content.
The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.