Optimal timing for cardioversion in patients with atrial fibrillation

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http://hdl.handle.net/10138/238890

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FinCV Investigators 2018 , ' Optimal timing for cardioversion in patients with atrial fibrillation ' , Clinical Cardiology (Hoboken) , vol. 41 , no. 7 , pp. 966-971 . https://doi.org/10.1002/clc.22986

Title: Optimal timing for cardioversion in patients with atrial fibrillation
Author: FinCV Investigators
Date: 2018-07
Language: eng
Number of pages: 6
Belongs to series: Clinical Cardiology (Hoboken)
ISSN: 0160-9289
URI: http://hdl.handle.net/10138/238890
Abstract: Background: Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown. Hypothesis: Timing of CV in AF is associated with risk of adverse events. Methods: We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30-day follow-up. Results: Study groups were stratified according to duration of index AF episode ( 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (30d), respectively (P <0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (30d), respectively (P <0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P <0.01) in multivariate analysis. Conclusions: Optimal timing of CV for AF showed a J-shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm-control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.
Subject: Arrhythmic Complications
Atrial Fibrillation
Cardioversion
Recurrence
Success Rate
Thromboembolism
UNSUCCESSFUL ELECTRICAL CARDIOVERSION
RISK
COMPLICATIONS
PREDICTION
RECURRENCE
STROKE
TIME
3121 General medicine, internal medicine and other clinical medicine
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