Key result
Failed electrical cardioversion during the blanking period was associated with a significantly higher risk of late recurrence of atrial fibrillation compared to successful cardioversion (HR 3.00).
Why the study?
The study evaluated the association between the timing and success of electrical cardioversion for early recurrences of atrial fibrillation after pulmonary vein isolation and long-term rhythm outcomes.
Does early electrical cardioversion (≤ 7 days) improve long-term rhythm outcomes compared to delayed cardioversion in patients with early recurrences of atrial fibrillation post pulmonary vein isolation?
Cohort (n=133)
No
Does early electrical cardioversion (≤ 7 days) improve long-term rhythm outcomes compared to delayed cardioversion in patients with early recurrences of atrial fibrillation post pulmonary vein isolation?
Hazard Ratio: 3 (95% CI 1.79–5.03)
Absolute Event Rate: 100% vs 68.4%
p-value: p=<0.001
In patients with early recurrence of atrial fibrillation after pulmonary vein isolation, failed electrical cardioversion and delayed cardioversion (>7 days from onset) are strong independent predictors of late recurrence.
Failed ECV post-ablation was associated with higher late recurrence; hypothesis-generating for timing and requires prospective validation.
BACKGROUND: To study the association between timing and success of electrical cardioversion (ECV) for the treatment of early recurrences (ERs) of atrial fibrillation post pulmonary vein isolation (PVI) on long-term rhythm outcome. METHODS: Data of 133 patients ablated for paroxysmal or persistent atrial fibrillation receiving ECV for ERs, i.e., atrial tachyarrhythmia recurrences within 90 days post ablation were analyzed. During 1-year follow-up, patients were screened for late recurrences (LRs), i.e., recurrences after the blanking period. RESULTS: In 114 patients (85.7%), ECV was successful compared to 19 patients (14.3%) with failed ECV. A higher body mass index (odds ratio (OR) 1.19 (95% CI 1.02-1.39), p = 0.029), a lower left ventricular ejection fraction (OR 1.07 (95% CI 0.99-1.15), p = 0.079), and performance of ECV > 7 days from ER onset (OR 2.99 (95% CI 1.01-8.87), p = 0.048) remained independently associated with ECV failure. During 1-year follow-up, the rate of LR was significantly higher among patients with failed ECV as compared to patients with successful ECV (hazard ratio (HR) 3.00 (95% CI, 1.79-5.03), p < 0.001). Patients with ECV performed > 7 days from ER onset had a significantly higher risk of developing LR as compared to patients with ECV performed within ≤ 7 days from ER onset (HR 1.73 (95% CI 1.15-2.62), p = 0.009). Performance of ECV > 7 days from ER onset (HR 1.76 (95% CI 1.16-2.67), p = 0.008) and failed ECV (HR 3.32 (95% CI 1.96-5.64), p < 0.001) remained independently associated with LR. CONCLUSIONS: A failed ECV and performance of ECV > 7 days from ER onset were independently associated with LR.
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Olshausen et al. (2022) conducted a cohort in Early recurrences of atrial fibrillation post pulmonary vein isolation (n=133). Failed electrical cardioversion vs. Successful electrical cardioversion was evaluated on Late recurrence of atrial tachyarrhythmias (after the 3-month blanking period) (HR 3.00, 95% CI 1.79-5.03, p=<0.001). Failed electrical cardioversion during the blanking period was associated with a significantly higher risk of late recurrence of atrial fibrillation compared to successful cardioversion (HR 3.00).
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