Key result
Delayed cardioversion lowers resting heart rate during AF recurrences by ~12 bpm versus early cardioversion.
Why the study?
This prespecified sub-analysis aimed to evaluate heart rate during AF recurrences after an emergency department visit identified by an ECG-based handheld device.
Does a delayed cardioversion strategy improve heart rate control during AF recurrences in patients with recent-onset atrial fibrillation?
RCT (n=335)
randomized
Does a delayed cardioversion strategy improve heart rate control during AF recurrences in patients with recent-onset atrial fibrillation?
A delayed cardioversion strategy for recent-onset atrial fibrillation is associated with a more favorable resting heart rate profile during subsequent AF recurrences compared to early cardioversion.
Supports delayed cardioversion for better rate control during AF recurrences; extends RCT evidence on timing strategies in recent-onset AF.
BACKGROUND: In the Rate Control versus Electrical Cardioversion Trial 7-Acute Cardioversion versus Wait and See, patients with recent-onset atrial fibrillation (AF) were randomized to either early or delayed cardioversion. AIM: This prespecified sub-analysis aimed to evaluate heart rate during AF recurrences after an emergency department (ED) visit identified by an electrocardiogram (ECG)-based handheld device. METHODS: After the ED visit, included patients (n = 437) were asked to use an ECG-based handheld device to monitor for recurrences during the 4-week follow-up period. 335 patients used the handheld device and were included in this analysis. Recordings from the device were collected and assessed for heart rhythm and rate. Optimal rate control was defined as a target resting heart rate of <110 beats per minute (bpm). RESULTS: In 99 patients (29.6%, mean age 67 ± 10 years, 39.4% female, median 6 [3-12] AF recordings) a total of 314 AF recurrences (median 2 [1-3] per patient) were identified during follow-up. The average median resting heart rate at recurrence was 100 ± 21 bpm in the delayed vs 112 ± 25 bpm in the early cardioversion group (p = .011). Optimal rate control was seen in 68.4% [21.3%-100%] and 33.3% [0%-77.5%] of recordings (p = .01), respectively. Randomization group [coefficient -12.09 (-20.55 to -3.63, p = .006) for delayed vs. early cardioversion] and heart rate on index ECG [coefficient 0.46 (0.29-0.63, p < .001) per bpm increase] were identified on multivariable analysis as factors associated with lower median heart rate during AF recurrences. CONCLUSION: A delayed cardioversion strategy translated into a favorable heart rate profile during AF recurrences.
No takes yet. Share an insight, caveat, or question.
Velden et al. (2023) conducted an RCT in recent-onset atrial fibrillation (AF) (n=335). Delayed cardioversion vs. Early cardioversion was evaluated on average median resting heart rate at recurrence (bpm) (coefficient -12.09, 95% CI -20.55 to -3.63, p=.006). Delayed cardioversion resulted in a lower median resting heart rate during AF recurrences compared to early cardioversion (100 vs 112 bpm; coefficient -12.09; 95% CI -20.55 to -3.63; p=0.006).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: