Key result
Electrical cardioversion restores sinus rhythm in ~98% of post-valve replacement permanent AF vs drugs.
Why the study?
The comparative efficacy of electrical versus pharmacological cardioversion in permanent AF after prosthetic cardiac valve replacement was unclear.
Does electrical cardioversion improve reversion to sinus rhythm compared to pharmacological cardioversion in patients with permanent atrial fibrillation after prosthetic cardiac valve replacement?
RCT (n=115)
randomly divided
Does electrical cardioversion improve reversion to sinus rhythm compared to pharmacological cardioversion in patients with permanent atrial fibrillation after prosthetic cardiac valve replacement?
Absolute Event Rate: 98.3% vs 26.8%
Electrical cardioversion is highly effective and superior to pharmacological cardioversion for restoring sinus rhythm in patients with permanent atrial fibrillation after prosthetic valve replacement who have normalized heart size.
Supports electrical cardioversion preference after valve replacement in permanent AF; extends RCT evidence to this post-surgical population.
OBJECTIVE: To compare the efficacy of electrical versus pharmacological cardioversion following prosthetic cardiac valve replacement in patients with permanent atrial fibrillation (AF). METHODS: Patients with permanent AF who had undergone prosthetic cardiac valve replacement, who had a cardiothoracic ratio ≤ 0.5 and a left atrial diameter ≤ 50 mm for ≥ 6 months after surgery were randomly divided to receive either electrical or pharmacological cardioversion. Patients in the electrical cardioversion group were given direct-current synchronized electrical defibrillation under general anaesthesia. Patients in the pharmacological cardioversion group were given oral combination therapy with amiodarone, captopril and simvastatin for 3 months. RESULTS: A total of 115 patients received either electrical cardioversion (n = 59) or pharmacological cardioversion (n = 56); reversion to sinus rhythm occurred in 98.3% and 26.8%, respectively. Recurrence rates were similar in the two groups (3.4% and 6.7% for electrical and pharmacological cardioversion, respectively). No deaths or severe complications were reported. CONCLUSION: Electrical cardioversion has a favourable safety profile and appears to be a more effective method than pharmacological cardioversion for the treatment of permanent AF after cardiac valve replacement, once the heart has returned close to its normal size.
No takes yet. Share an insight, caveat, or question.
Chen et al. (2013) conducted an RCT in permanent atrial fibrillation after prosthetic cardiac valve replacement (n=115). Electrical cardioversion vs. Pharmacological cardioversion (amiodarone, captopril and simvastatin) was evaluated on reversion to sinus rhythm. Electrical cardioversion was more effective than pharmacological cardioversion for reversion to sinus rhythm in patients with permanent AF after valve replacement (98.3% vs 26.8%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: