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Introduction Electrical cardioversion (ECV) plays a key role in the management of symptomatic patients with persistent atrial fibrillation (AF) requiring a rhythm control strategy. Predictors for ECV to restore sinus rhythm in persistent AF are arrhythmia duration, patient age, presence of comorbidities and pre-treatment with antiarrhythmic drugs (AADs)1,2. The study's primary aim was to determine the relationship between periprocedural use of AADs and the success of ECV in patients with persistent atrial fibrillation that have undergone ECV at University Hospital of North Tees. A successful outcome post-ECV was defined as the patient leaving the hospital on the day in sinus rhythm. By recording various patient characteristics, this study showcases predictors of both successful ECV, and subsequent maintenance of sinus rhythm in the studied population. Methods Our service evaluation project comprised a retrospective case control study. 71 patients with symptomatic AF were included that were referred for elective ECV at our Cardiology Outpatient Day Unit, between November 2022 and November 2023. Data collection started November 2023 by reviewing patients' notes, recording their ECV outcome on the day, and maintenance of sinus rhythm at 5 weeks (Fig 1). At each point, the prevalence of predictive factors for ECV success and maintenance of sinus rhythm was analysed, focusing on basic demographics, elements of past medical history, AAD use pre- and post-ECV, social history, pre-ECV echocardiography reports and biochemical investigations. Results There were considerable differences in prevalence of some predictors between the successful and unsuccessful ECV groups, as shown in table 1. On the day, the main predictor for ECV restoring sinus rhythm was the pre-procedure use of AADs, in particular amiodarone. Predictors of an unsuccessful outcome included higher alcohol consumption, longer time spent in AF, a dilated LA and a history of HTN. The predictors of sinus rhythm maintenance at 5 weeks follow up are illustrated in table 2. Pre- and post-procedure amiodarone use seem to correlate with maintenance of sinus rhythm. Conversely, a dilated LA and the presence of hypertension were associated with the return of AF. Conclusions Amiodarone administration before ECV appears to corelate with a successful outcome on the day of cardioversion. AAD continuation post-successful ECV, in particular amiodarone, represents a positive predictor for maintenance of sinus rhythm. Further research is required to determine the ability of amiodarone to improve ECV outcomes, and to what extent this represents a reasonable solution in clinical practice. Conflict of Interest None
Firescu et al. (Mon,) studied this question.