216-71: Reduction of recurrence of atrial fibrillation after electrical cardioversion by Dabigatran-etexilate

Abstract

Background: Electrical cardioversion (ECV) is a fast and secure method to establish sinus rhythm immediately in patients with symptomatic atrial fibrillation (AF). Unfortunately recurrence rate of AF after ECV is still high. Different agents such as antiarrhythmic or antiinflammatory drugs can improve the long term rhythm outcome. The direct thrombin inhibitor, dabigatran-etexilate, has a pleiotropic mechanism of action, with potential antioxidative, antiinflammatory and antifibroblastic growth effect. Its influence on recurrence after ECV has not yet been studied. Methods: We performed an analysis of 142 patients (98 men, mean age 65 ± 10 years, 57% on antiarrhythmic therapy, 49% persistent AF) who underwent ECV and were anticoagulated with either dabigatran-etexilate (n = 78) or phenprocoumon (n = 64). Results: During the mean follow up of 19 ± 8 months an AF recurrence was observed in 65 patients (45.8%). Baseline characteristics of both patient groups were similar despite the fact, diabetes mellitus (28.5% vs. 7.8%, p = 0.003) was more frequent in the dabigatran group (Table 1). Although persistent AF was more frequent in patients with dabigatran (73% vs. 20%, p < 0.001) the mean AF free survival was significantly longer in this group (17 ± 1 months vs. 10 ± 2 months, p < 0.001) (Figure 1).In the multivariate analysis including all baseline characteristics the use of dabigatran was associated with improved rhythm outcome (HR 0.30, CI 95% 0.18-0.51, p < 0.001). Conclusion: The results suggest a positive effect of dabigatran on preventing recurrence of AF after successful ECV. This effect may derive from its pleiotropic mechanism of action. Further clarification of potential mechanisms and evaluation in larger multicenter trials is needed.