Clinical correlates of immediate success and outcome at 1-year follow-up of real-world cardioversion of atrial fibrillation: the Euro Heart Survey.

Abstract

AIMS:

In atrial fibrillation (AF) cardioversion is the cornerstone of the rhythm management strategy despite the lack of contemporary data on acute and long-term success. We aim to describe present-day cardioversion of AF and identify characteristics associated with immediate and long-term outcome.

METHODS AND RESULTS:

Based on the 5333 AF patients enrolled in the multi-centre prospective Euro Heart Survey on AF we selected the 1801 patients undergoing cardioversion at enrolment. Sinus rhythm (SR) was restored in 630 of 712 (88%), 458 of 643 (71%), and 333 of 446 (75%) (P< 0.001) of the electrical (ECV), intravenous (ivCCV), and oral (oCCV) chemical cardioversions, respectively, at the cost of few (4.2%) major complications. In multivariate analysis, absence of chronic obstructive pulmonary disease (COPD) (P< 0.001), presence of paroxysmal AF (PAF) (P= 0.013), and use of biphasic waveform (P= 0.018) were predictors of successful ECV. For ivCCV PAF (P< 0.001), absence of valvular heart disease (P= 0.004), and heart failure (P= 0.009), the presence of hypertension (P= 0.018) and coronary artery disease (P= 0.007) were predictive. Success of oCCV was driven by PAF (P< 0.001) and a smaller left atrial dimension (P= 0.001). At 1-year follow-up 893 of 1271 (70%) patients were in SR. Multivariate analysis revealed PAF (P< 0.001), shorter total AF history (P< 0.001), continuous use of Class Ic drugs or amiodarone during follow-up (P< 0.001), absence of COPD (P= 0.003), younger age (P= 0.004), and smaller left atrial dimension (P= 0.005) as independent predictors of SR at 1-year follow-up.

CONCLUSIONS:

Contemporary cardioversion of AF is routinely successfully and safely performed with a high proportion of patients in SR at 1-year follow-up.

• Authors: Ron Pisters, Robby Nieuwlaat, Martin H Prins, Jean-Yves Le Heuzey, Aldo P Maggioni, A John Camm, Harry J G M Crijns, Euro Heart Survey Investigators
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 14 Issue 5 Pg. 666-74 (May 2012) ISSN: 1532-2092 [Electronic] England
• PMID: 22223715 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Anti-Arrhythmia Agents
• Anticoagulants

Topics

• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (drug therapy, epidemiology, therapy)
• Coronary Artery Disease (epidemiology)
• Data Collection
• Electric Countershock (statistics & numerical data)
• Europe (epidemiology)
• Female
• Follow-Up Studies
• Heart Failure (epidemiology)
• Heart Valve Diseases (epidemiology)
• Humans
• Hypertension (epidemiology)
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Pulmonary Disease, Chronic Obstructive (epidemiology)
• Recurrence
• Treatment Outcome