P3792The impact of elective cardioversion for atrial fibrillation in heart failure patients

Abstract

Abstract Introduction Severe left ventricular systolic dysfunction (LVSD) is associated with worse outcomes in heart failure (HF) patients. Persistent atrial fibrillation (AF) is common in this patient group. As part of a nurse-led cardioversion service at a district general hospital we assessed the impact of elective cardioversion (DCCV) for AF in patients with LVSD on their ejection fraction (EF), and compared outcomes in patients selectively pre-treated with amiodarone for their DCCV. Methods A retrospective analysis was undertaken of DCCV for AF over 5 years, recording demographic, medication, serial echocardiogram (TTE), and outcome data. Significant LVSD was classified as moderate (ejection fraction [EF] 35–45%) or severe (EF<35%). All patients treated with amiodarone had baseline and serial thyroid, liver, renal function monitored, were counselled on side effects and followed up. Results 103 patients with significant LVSD and follow-up TTE underwent DCCV, with a median age of 66 (IQR 58–73) and mean CHA2DS2-VASc 2.5. Overall mean baseline EF was 30% (SD ±11), overall follow-up EF (regardless of repeat TTE rhythm) was 42% (SD ±12), and the mean delta EF +12% improvement (SD ±11). At follow-up TTE, 66% (68/103) of patients were in sinus rhythm (SR) and 34% (35/103) in AF. 62/68 (91%) patients in SR at follow-up TTE were also treated with HF medications, vs 33/35 (94%) of those in AF. 61/68 (90%) of patients in SR at follow-up TTE had any improvement in EF vs 21/35 (60%) patients in AF (p=0.0007). For patients in SR the mean baseline EF was 31% (SD ±10) and mean follow-up EF 47% (SD ±9), vs the AF at repeat TTE patients' mean baseline EF 27% (SD ±12) and mean follow-up EF 35% (SD ±13). The mean delta EF of patients still in SR at follow-up scan was 15% (SD ±10) vs 8% (SD ±11) for patients who had reverted to AF (p=0.0004). Prior analysis of our data-set including patients awaiting repeat TTE demonstrated a significant improvement in 6 month AF recurrence rate. Table 1. Comparing outcomes with amiodarone pre-treatment for patient with follow-up EF data Acute DCCV Success Mean Baseline EF Mean Repeat EF Mean Delta EF AF Recurrence to 6 months Amiodarone 17/17 (100%) 29% (SD 11) 45% (SD 11) 15% (SD 13) 6/17 (35%) No Amiodarone 80/86 (93%) 30% (SD 11) 42% (SD 12) 12% (SD 10) 50/86 (58%) P value 0.59 0.22 0.11 Conclusion Restoration of SR in a cohort of patients with AF, severe LVSD, on good medical therapy significantly improves left ventricular EF. This reinforces the importance of maintaining SR for HF patients. There was also a trend towards improved medium term outcomes in patients pre-treated with amiodarone. Further study into long-term rhythm control and ablation outcomes is needed.