CHESS
WHAT IS IT?
WHY DO WE CARE?
RESULTS
KEY MESSAGES
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Comparison of High vs. Escalating Shocks (CHESS) trial
SINGLE-CENTER, SINGLE-BLINDED, RANDOMIZED TRIAL


Maximum Fixed (360-360-360J)
VS.
Low-Escalating (125-150-200J)
elective cardioversion for AF

1° endpoint: sinus rhythm at 1 min after cardioversion
2° endpoints: any Arrhythmia at 4 hr, myocardial injury by TnI, and skin discomfort

Schmidt et al. Eur Heart J 2019.
WHY DO WE CARE? Optimal Energy for DC Cardioversion is Unknown.
Maximum Energy
more effective.
less time in sedation.
higher chance of myocardial & skin injury.
potentially cause post shock arrhythmias.
Low-Escalating Energy
less effective.
more time in sedation.
less injury.
potentially induce another arrhythmia.
  Max Fixed
(N=129) 		Low-Escalating
(N=147)
1st shock success 88% 66%
Cumulative Energy (J) 360 275
Procedure Time (min) 1.9 (1.5-2.7) 2.2 (1.7-3.0)
Arrhythmia Complications 5% 5%
Skin redness beneath anterior pad 33% 31%
CHANGE in hs-TnI (ng/L) 0 (0 to 0) 0 (-1 to 0)
KEY MESSAGES
Maximum-Fixed Energy Shocks
were more efficient compared with low-escalating energy shocks for cardioversion of atrial fibrillation.
There was no difference in safety endpoints.