Difference of Outcome of Patients who Were Referred From General Cardiology Clinic and EP Clinic: An Auckland Hospital Experience

Abstract

Atrial fibrillation (AF) and atrial flutter (AFL) are increasing in prevalence. DC-cardioversion (DCCV) is an intervention performed for achieving rhythm control. We performed a single-centre retrospective study to explore for any difference in outcome of patients who were referred from the general cardiology clinic and EP (electrophysiology) clinic. Patients who underwent elective DCCV referred between referral dates 15 October 2010 to 30 January 2020 were included in this study. Primary endpoint was anti-arrhythmic agents and electrophysiology (EP) procedures used for these 2 groups. A total of 503 patients were identified. 364 patients and 139 patients were referred from the general cardiology clinic and EP clinic, respectively. Both groups were similar in baseline characteristics. Successful DCCV and rhythm at follow up were similar for both groups, accounting for 90% and 59% of patients, respectively. Those referred from EP clinic were more likely to be on amiodarone (p=0.04) and flecainide (p<0.01). More patients referred from EP clinic had AFL ablation (11% vs 5% in the general cardiology group, p=0.03) but there was no difference in AF ablation or AV junction (AVJ) ablation. Successful DCCV and rate of sinus rhythm maintenance at follow up clinic were similar for those referred from the general cardiology and the EP cardiology clinic. More patients were on amiodarone and flecainide and more AFL ablations were performed in the cohort referred by the EP cardiology clinic. DCCV is still a reasonable intervention for achieving rhythm control, but if it failed to maintain sinus rhythm, some patients are better off with a rate-control strategy.