We would like to thank Nguyen et al. for engaging with our systematic review and meta-analysis¹ and for your critical observations.² Regarding the omission of four studies, our inclusion criteria were rigorously followed, which led to the exclusion of studies that did not meet these predefined standards. Specifically, three of these studies were either not in English or inaccessible in full text, preventing their inclusion.^{3, 4} The fourth study focused primarily on a subgroup analysis of patients with obesity, which did not align with our broader inclusion criteria encompassing all patient demographics, not limited to specific conditions like obesity.⁵

Concerning the inclusion of a prospective study, it appears there was a misunderstanding about the nature of the study we included. The study in question was a prospective interventional study, effectively functioning as a non-randomized clinical trial, which falls within our criteria of including both randomized and non-randomized clinical trials.⁶ This inclusion aligns with our commitment to a comprehensive analysis of clinical trials relevant to our research question.

As for the issue of data extraction, particularly regarding the studies by Alp et al.⁷ and Botto et al.,⁸ our methodology adhered strictly to the principles of accurate data appraisal. The overall cardioversion rates utilized in our analysis were directly reflective of the outcomes post-application of DC shock and high energy, consistent with the intentions of the original studies. We believe this approach maintains the integrity of our analysis and supports the validity of our findings.

We acknowledge the value of constructive critique and the importance of rigorous debate in advancing scientific understanding. As the field moves forward, especially with ongoing trials like NCT05511389, we anticipate further clarification on optimal practices, including electrode pad placement. Our study contributes to this ongoing dialogue, and we advocate for continued research that incorporates best practices alongside new interventions.

我们要感谢 Nguyen 等人。参与我们的系统评价和荟萃分析¹以及您的批判性观察。²关于四项研究的遗漏，我们严格遵循了纳入标准，这导致排除了不符合这些预定标准的研究。具体来说，其中三项研究要么不是英文版，要么无法获取全文，从而无法被纳入。^{3, 4}第四项研究主要关注肥胖患者的亚组分析，这与我们涵盖所有患者人口统计数据的更广泛的纳入标准不符，不限于肥胖等特定情况。⁵

关于纳入前瞻性研究，我们似乎对纳入的研究的性质存在误解。该研究是一项前瞻性干预研究，有效地充当非随机临床试验，符合我们纳入随机和非随机临床试验的标准。⁶这一纳入符合我们对与我们的研究问题相关的临床试验进行全面分析的承诺。

至于数据提取的问题，特别是 Alp 等人的研究。⁷和 Botto 等人，⁸我们的方法严格遵守准确数据评估的原则。我们分析中使用的总体心脏复律率直接反映了应用直流电击和高能量后的结果，与原始研究的目的一致。我们相信这种方法可以保持我们分析的完整性并支持我们研究结果的有效性。

我们承认建设性批评的价值以及严格辩论对于推进科学理解的重要性。随着该领域的发展，特别是像 NCT05511389 这样的正在进行的试验，我们预计最佳实践将得到进一步澄清，包括电极垫的放置。我们的研究有助于这种持续的对话，我们主张继续研究，将最佳实践与新的干预措施结合起来。