Double Consecutive Electrical Countershock for Atrial and Ventricular Fibrillation: A Narrative Critical Review.
- 1Carle Illinois College of Medicine, Urbana, Illinois, USA.
- 2Department of Cardiology, Sarah Bush Lincoln Health Center, Mattoon, Illinois, USA.
Abstract
Background
Recent strategies for refractory ventricular fibrillation (VF) and atrial fibrillation (AF) employ two consecutive, biphasic shocks with varying evidence of success. Due to their electrophysiological similarities, the strategies used for VF and AF can be collectively referred to as double consecutive electrical countershock (DCEC). This review aims to identify and synthesize outcome data on the effectiveness of DCEC across both VF and AF.Methods
This narrative critical review with systematic search methods was conducted in accordance with the PRISMA checklist where applicable. From 672 identified articles, 262 duplicates were removed and 410 screened; 316 articles irrelevant to the study were excluded. Of 94 sought for retrieval, 8 were unavailable and 67 failed full-text screening, leaving 19 included articles (16 VF, 3 AF). All 19 underwent risk-of-bias assessment (RoB2, ROBINS-I, or AMSTAR-2) and data extraction.Results
Full-scale randomized controlled trials (RCTs) showed low risk of bias, pilot RCTs had "some concerns," observational studies carried serious risk of bias, and meta-analyses showed "low confidence." High-quality randomized evidence showed improved primary outcomes for DCEC in both refractory VF (survival to discharge, return of spontaneous circulation, good neurological outcome) and high-BMI AF (arrhythmia termination). Non-randomized observational studies predominantly showed non-statistically significant differences.Conclusions
DCEC shows potential to improve arrhythmia termination in refractory VF and high-BMI AF. Randomized evidence supports its efficacy, while observational findings remain neutral due to confounding. Success in high-BMI AF supports elevated BMI as a hypothetical indication for DCEC in VF.
Related
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- Radiofrequency ablation with a conventional solid tip catheter in contact with an implantable cardioverter-defibrillator coil causing inadvertent ventricular fibrillation.
- Ventricular fibrillation treated by an implantable cardioverter-defibrillator in antimitochondrial M2 antibody-positive myocarditis.
- Association Between Left Atrial Enlargement and Atrial Fibrillation in Elderly Patients with Left Ventricular Diastolic Dysfunction
BibTeX
@article{ray2026double,
title = {{Double Consecutive Electrical Countershock for Atrial and Ventricular Fibrillation: A Narrative Critical Review.}},
author = {Ian Ray and Varun Gopal and Brian Ellis and Abraham Kocheril},
journal = {Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc},
year = {2026},
month = nov,
doi = {10.1111/anec.70251},
url = {https://europepmc.org/article/MED/42969027},
note = {CC BY},
}
RIS
TY - JOUR
TI - Double Consecutive Electrical Countershock for Atrial and Ventricular Fibrillation: A Narrative Critical Review.
AU - Ian Ray
AU - Varun Gopal
AU - Brian Ellis
AU - Abraham Kocheril
PY - 2026
DA - 2026/11/01
JO - Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
DO - 10.1111/anec.70251
UR - https://europepmc.org/article/MED/42969027
AB - Background Recent strategies for refractory ventricular fibrillation (VF) and atrial fibrillation (AF) employ two consecutive, biphasic shocks with varying evidence of success. Due to their electrophysiological similarities, the strategies used for VF and AF can be collectively referred to as double consecutive electrical countershock (DCEC). This review aims to identify and synthesize outcome data on the effectiveness of DCEC across both VF and AF.Methods This narrative critical review with systematic search methods was conducted in accordance with the PRISMA checklist where applicable. From 672 identified articles, 262 duplicates were removed and 410 screened; 316 articles irrelevant to the study were excluded. Of 94 sought for retrieval, 8 were unavailable and 67 failed full-text screening, leaving 19 included articles (16 VF, 3 AF). All 19 underwent risk-of-bias assessment (RoB2, ROBINS-I, or AMSTAR-2) and data extraction.Results Full-scale randomized controlled trials (RCTs) showed low risk of bias, pilot RCTs had "some concerns," observational studies carried serious risk of bias, and meta-analyses showed "low confidence." High-quality randomized evidence showed improved primary outcomes for DCEC in both refractory VF (survival to discharge, return of spontaneous circulation, good neurological outcome) and high-BMI AF (arrhythmia termination). Non-randomized observational studies predominantly showed non-statistically significant differences.Conclusions DCEC shows potential to improve arrhythmia termination in refractory VF and high-BMI AF. Randomized evidence supports its efficacy, while observational findings remain neutral due to confounding. Success in high-BMI AF supports elevated BMI as a hypothetical indication for DCEC in VF.
SN - 1082-720X
SN - 1542-474X
ER -