Use of antiarrhythmics before and after successful electrical cardioversion independently predicted maintenance of sinus rhythm at one year (OR 3.345; 95% CI 1.16-9.65; P=0.026).
Observational (n=297)
No
Sinus rhythm is maintained at one year in approximately 40% of patients following successful cardioversion for persistent AF/AFL, with higher success rates in non-smokers, those with smaller left atria, lower CHA2DS2-VASc scores, no prior ECV, and peri-procedural antiarrhythmic use.
Odds Ratio: 3.345 (95% CI 1.16–9.65)
p-value: p=0.026
Abstract Background Despite the high success rate of electrical cardioversion (ECV) in terminating atrial fibrillation (AF) and atrial flutter (AFL), long-term maintenance of sinus rhythm (SR) remains a significant clinical challenge. Purpose To determine the factors independently associated with a higher probability of maintaining SR one year after successful elective ECV of persistent AF and AFL. Methods This is retrospective, observational study, conducted among patients who underwent elective ECV for persistent AF or AFL between January 2011 and June 2023. All procedures were performed in the operating room by an internal medicine specialist, under intravenous analgosedation administered by an anesthesiologist. Shocks were delivered using an external defibrillator in all patients except in those with implantable cardioverter defibrillators in whom internal shocks were attempted. If the first shock was ineffective, subsequent shocks were delivered at maximum energy, with up to three total shocks. ECV was deemed successful if SR was confirmed on both ECG recordings, immediately after cardioversion and 30 minutes later. To confirm the maintenance of SR, asymptomatic patients underwent an ECG at the first monthly check-up and then at regular quarterly check-ups, while patients who experienced arrhythmia underwent an ECG at the nearest healthcare facility and then, if necessary, an ECG Holter monitor at our Center. Results This study included 297 ECV procedures, each performed on a different patient (75.4% male, mean age 63.9 ± 11.4 years). In two-thirds of patients, the reason for elective ECV was AF. The median time from first arrhythmia diagnosis to attempted ECV was 14 months. ECV was successful in 273 patients (91.9%). At one-year follow-up, SR was maintained in 110 patients, representing 40.3% of all patients with initially successful ECV. Using multivariate logistic regression analysis we identified following factors as independent predictors associated with a higher probability of maintaining SR one year after successful ECV: shorter duration of the index arrhythmia episode (OR = 0.907, 95%CI OR = 0.83-0.99, p = 0.024), smaller left atrium (LA) dimensions (OR = 0.928, 95%CI OR = 0.87-0.99, p = 0.021), non-smoking status (OR = 0.265, 95%CI OR = 0.14-0.50, p 0.001), CHA 2 DS 2 -VASc score less than or equal to 3 (OR = 0.371, 95%CI OR = 0.17-0.82, p = 0.015), absence of previous ECV (OR = 0.301, 95%CI OR = 0.12-0.74, p = 0.008) and the use of antiarrhythmics both before and after successful ECV (OR = 3.345, 95%CI OR = 1.16-9.65, p = 0.026). Conclusion ECV as part of a rhythm control strategy in AF/AFL is reasonable when this procedure has not been performed previously, when the patient is less burdened by comorbidities, has a smaller LA, is prepared for the procedure with antiarrhythmics, and does not smoke. The procedure should be performed as soon as possible after the arrhythmia is detected.
Radovanovic et al. (Mon,) conducted a observational in persistent atrial fibrillation and atrial flutter (n=297). Antiarrhythmics before and after successful ECV vs. No antiarrhythmics was evaluated on Maintenance of sinus rhythm one year after successful ECV (OR 3.345, 95% CI 1.16-9.65, p=0.026). Use of antiarrhythmics before and after successful electrical cardioversion independently predicted maintenance of sinus rhythm at one year (OR 3.345; 95% CI 1.16-9.65; P=0.026).