Key result
ICD shock testing in patients with atrial fibrillation resulted in successful cardioversion to sinus rhythm in 77% of cases, though 89% of these experienced recurrence after a median of 54 days.
Why the study?
Does ICD shock testing result in sustained sinus rhythm in patients with concurrent atrial fibrillation?
Cohort (n=57)
No
Does ICD shock testing result in sustained sinus rhythm in patients with concurrent atrial fibrillation?
Incidental cardioversion of AF during ICD shock testing has a high early recurrence rate, suggesting anticoagulation should not be stopped based on post-shock sinus rhythm.
High early AF recurrence after shock-induced cardioversion during ICD implantation cautions against basing anticoagulation on immediate post-test rhythm; leaves open optimal periprocedural strategies.
BACKGROUND: Many patients receiving an implantable cardioverter-defibrillator (ICD) also have atrial fibrillation (AF). Shock testing during ICD implantation carries a potential risk of cardioversion to sinus rhythm (SR) and thrombembolic events. We aimed to analyze the recurrence of AF after cardioversion to SR during ICD shock testing. METHODS: A total of 555 consecutive patients referred to a tertiary hospital in Switzerland for ICD implantation or generator exchange between 02/2002 and 03/2010 were screened for AF. Fifty-seven patients who were in AF at the time of ICD shock testing were included. RESULTS: Forty-four patients (77%) were successfully cardioverted from AF to SR. Type of AF (persistent, not permanent 64 vs 31% of cardioverted patients) was the only predictor. Thirty-nine patients (89%) experienced a recurrence of AF/atrial flutter after a median of 54 days (interquartile range 35-251 days). The only predictor for recurrence of AF was previous AF declared as permanent. No ischemic stroke occurred during hospitalization for the procedure. CONCLUSIONS: For patients in AF undergoing shock testing at the time of ICD implant, there is a high chance of cardioversion from AF to SR, but there is also a high risk of early recurrence. Decisions regarding long-term anticoagulation should not be based on the heart rhythm immediately following shock testing.
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Vischer et al. (2015) conducted a cohort in Atrial fibrillation (n=57). ICD shock testing was evaluated on Cardioversion from AF to SR. ICD shock testing in patients with atrial fibrillation resulted in successful cardioversion to sinus rhythm in 77% of cases, though 89% of these experienced recurrence after a median of 54 days.
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