Frequency, causes and predictors for cancellation of elective electrical cardioversion of atrial fibrillation and flutter

Background Elective electrical cardioversion (ECV) is widely used to restore sinus rhythm in patients with atrial fibrillation or atrial flutter (AF/AFL). Although ECV is a routine procedure, there is a lack of contemporary data on its resource utilisation, particularly in the era of direct oral anticoagulants. Purpose To analyse the frequency and causes of cancelled ECV procedures in patients with AF/AFL, and to identify predictors of cancellation. Methods This retrospective observational study included patients who presented for ECV at our University Hospital between January 2022 and December 2023. Data were extracted from medical records and analysed using logistic regression. Results A total of 862 patients were included in the study and scheduled for a total of 1 531 ECV. Of these planned procedures, 212 ECV (14%) were cancelled upon admission. Spontaneous restoration of sinus rhythm was the primary cause of ECV cancellation (135 procedures, 64%), followed by inadequate adherence to anticoagulation therapy (37 procedures, 17%). The remaining 40 cancellations (19%) were due to other clinical reasons, including heart failure decompensation (9 procedures), re-evaluation of the indication (9 procedures), and hypokalaemia (8 procedures). In multivariable logistic regression analyses, first-time ECV and a prior diagnosis of paroxysmal AF were independently associated with a higher likelihood of ECV cancellation (Figure and Table). Conclusions In AF/AFL patients who presented for ECV, the cancellation rate was 14%, with spontaneous restoration of sinus rhythm and inadequate adherence to anticoagulation therapy as its primary causes. First-time ECV and prior paroxysmal AF diagnosis were significant independent predictors of ECV cancellation. Identifying high-risk patients in advance may reduce unnecessary admissions and improve resource allocation.FigureTable