Non-pharmacological interventions to improve the success of electrical cardioversion in patients with atrial fibrillation

Abstract Background: Electrical cardioversion (ECV) is a common management strategy for atrial fibrillation (AF). ECV contains multiple modifiable components, including pad size and placement, shock energy, and waveform phases. Guidance on optimal technique, however, is limited. A comprehensive review of interventions used to increase ECV success will guide ideal clinical practice and identify techniques that could be studied in future randomized controlled trials. Methods: This review will include RCTs randomized controlled trial and observational studies that compare acute cardioversion success between 2 or more non-pharmacological interventions in patients with AF undergoing ECV. We will search CENTRAL, MEDLINE and EMBASE from inception to present and will also include the grey literature as part of our search. We will assess the risk of bias for each study and summarize the extracted data in a narrative report with a table of findings included. Results: Based on a full search strategy developed for MEDLINE along with findings from the grey literature search, the non-pharmacological interventions are expected to include pad placement, shock energy, waveform phases, and manual pressure, among others. Conclusions: The objective of this scoping review is to identify and examine the evidence on non-pharmacological interventions to improve electrical cardioversion in patients with AF. Registered on Open Science Framework: https://osf.io/gdh27/