Follow-up results of a cohort of patients undergoing electrical cardioversion. Recurrence and associated factors in the medium to long term

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Electrical cardioversion (ECV) is an effective therapeutic alternative for atrial fibrillation (AF) and atrial flutter (AFL); however, in the medium-long term, the recurrence rate is significant and the evidence is limited. Methods Retrospective, observational, single-center, retrospective registry of 154 consecutive cases of patients undergoing electrical cardioversion for AF or AF flutter of more than 48 hours of evolution. Recurrence, emergency visits, readmissions and new ECV were recorded during a mean follow-up of 34±11 months. Results The median time from diagnosis to ECV was 60 days. The success rate of ECV was 91.7%. The immediate recurrence rate (< 2 hours) was 3.9%. The incidence of recurrence during follow-up is shown in Table 1. Of the total number of recurrences, 12.7% were detected on Holter-ECG. During follow-up, 5.8% of the patients died, none due to cardiovascular causes, 33.1% of the patients were readmitted, 25.3% due to cardiovascular causes and 15.6% as a consequence of AF/AFL. A total of 17.5% of patients attended the emergency department for episodes of AF/AFL with rapid ventricular response. Up to 18.8% of patients underwent repeat ECV and 16.2% underwent pulmonary vein ablation; in contrast, 35.3% of patients opted for a rate control strategy. Previous ECV and atrial dilatation were associated with a higher (76.9% vs 52.6% p=0.02; 64.9% vs 24% p<0.001) and earlier recurrence of AF/AFL (18.2 months vs 29.9 months p=0.008; 24.1 months vs 41.1 months p=0.001). Treatment at discharge with antiarrhythmic drugs was not associated with less recurrence at 6, 12 months and final follow-up (Figure 1). Conclusion ECV is an effective therapy against AF and AFL, however, the recurrence rate in the medium-long term is high. Previous ECV and atrial dilatation are associated with a higher and earlier recurrence. Antiarrhythmic treatment had a neutral impact on the maintenance of sinus rhythm in the medium to long term.