Elective electrical cardioversion for atrial fibrillation resulted in 45.7% of patients maintaining sinus rhythm at 12 months, with sinus rhythm at 1 month strongly predicting success (OR 18.28).
Cohort (n=300)
What is the prevalence and what are the predictors of maintaining sinus rhythm at 12 months after elective electrical cardioversion in patients with atrial fibrillation?
Less than half of unselected patients maintain sinus rhythm 12 months after elective electrical cardioversion, but early re-evaluation at 1 month strongly predicts long-term success.
Effect estimate: OR 18.28 (95% CI 3.3-100)
p-value: p=0.001
AIMS: To evaluate the prevalence and predictors of persistent sinus rhythm in a recent cohort of unselected patients undergoing electrical cardioversion for atrial fibrillation. METHODS: We enrolled all consecutive patients undergoing elective electrical cardioversion for atrial fibrillation between January 2017 and December 2018. We analysed baseline clinical and echocardiographic data as well as pharmacological antiarrhythmic therapy. Primary endpoint was the maintenance of sinus rhythm at 12 months after electrical cardioversion. RESULTS: Of the 300 patients enrolled, 270 (90%) had successful electrical cardioversion and among them, 201 patients have 12-month follow-up data (mean age 70 ± 10 years; 74% men). At 12 months, only 45.7% were in sinus rhythm. Patients without sinus rhythm compared with persistent sinus rhythm at 12 months had a lower baseline left ventricle ejection fraction (LVEF) (49.1 ± 16 vs. 59.7 ± 9%, P = 0.02) and had more frequently a history of atrial fibrillation more than 12 months (55 vs. 34% P = 0.003). At the multivariate analysis, only the duration of the disease beyond 12 months (OR 0.26, 95% CI: 0.08-0.88, P = 0.032), LVEF (OR 1.06, 95% CI: 1.01-1.12, P = 0.012) and the presence of sinus rhythm at 1-month follow-up (OR 18.28, 95% CI: 3.3-100, P = 0.001) were associated with the probability of maintaining sinus rhythm at 12 months. CONCLUSION: In unselected patients with atrial fibrillation undergoing elective electrical cardioversion, only 45.7% were in sinus rhythm at 12 months. The presence of sinus rhythm at 1-month follow-up emerged as an independent predictor of maintenance of sinus rhythm. This highlights that early re-evaluation of these patients appears useful for assessing longer term outcomes also from the perspective of a possible selective approach to ablation strategies.
Castrichini et al. (Tue,) conducted a cohort in Atrial fibrillation (n=300). Elective electrical cardioversion was evaluated on Maintenance of sinus rhythm at 12 months after electrical cardioversion (OR 18.28, 95% CI 3.3-100, p=0.001). Elective electrical cardioversion for atrial fibrillation resulted in 45.7% of patients maintaining sinus rhythm at 12 months, with sinus rhythm at 1 month strongly predicting success (OR 18.28).