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Clin Cardiol. 2018 Jul;41(7):966-971. doi: 10.1002/clc.22986. Epub 2018 Jul 23.

Optimal timing for cardioversion in patients with atrial fibrillation.

Author information

1
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
2
Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland.
3
Department of Surgery, Turku University Hospital and University of Turku, Turku, Finland.
4
Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland.
5
Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
6
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland.

Abstract

BACKGROUND:

Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown.

HYPOTHESIS:

Timing of CV in AF is associated with risk of adverse events.

METHODS:

We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30-day follow-up.

RESULTS:

Study groups were stratified according to duration of index AF episode (<24 h, 24-48 h, 48 h-30d, and > 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (<24 h), 5.4% (24-48 h), 11.1% (48 h-30d), and 13.9% (>30d), respectively (P < 0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (<24 h), 26.5% (24-48 h), 37.3% (48 h-30d), and 30.3% (>30d), respectively (P < 0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P < 0.01) in multivariate analysis.

CONCLUSIONS:

Optimal timing of CV for AF showed a J-shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm-control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.

KEYWORDS:

Arrhythmic Complications; Atrial Fibrillation; Cardioversion; Recurrence; Success Rate; Thromboembolism

PMID:
29802625
DOI:
10.1002/clc.22986
[Indexed for MEDLINE]
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