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Electrical cardioversion for persistent atrial fibrillation or atrial flutter in clinical practice: predictors of long-term outcome.
Int J Clin Pract. 2007 May; 61(5):748-56.IJ

Abstract

Despite the results of Atrial Fibrillation Follow-up Investigation of Rhythm Management and Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation trials, which favour a general shift in atrial fibrillation (AF) therapeutic approach towards control of ventricular rate, a strategy based on restoration of sinus rhythm could still play a role in selected patients at lower risk of AF recurrence. We explored possible predictors of relapses after external electrical cardioversion among patients with persistent AF or atrial flutter (AFL). We analysed the clinical characteristics and conventional echocardiographic parameters of patients with persistent AF/AFL enrolled in an institutional electrical cardioversion programme. Among 242 patients (AF/AFL, 195/47; mean age 62+/-13 years), sinus rhythm was restored in 215 (89%) and maintained in 73 (34%) at a follow-up of 930 days (median). No baseline clinical/echocardiographic variables predicted acute efficacy of cardioversion at logistic regression analysis. However, two variables predicted long-term AF/AFL recurrence among patients with successful cardioversion at multivariate Cox's proportional hazards analysis: (i) duration of arrhythmia>or=1 year (HR, 2.07; 95% CI, 1.29-3.33) and (ii) presence of previous cardioversion (HR, 1.67; 95% CI, 1.17-2.38). These variables also presented high-positive predictive values (72% and 80% respectively). Whereas the high acute efficacy of electrical cardioversion (approximately 90%) does not appear to be predictable, two simple clinical variables could help identify patients at higher risk of long-term AF/AFL recurrence after successful electrical cardioversion. We think there could be a case for initially attempting external electrical cardioversion to patients who have had AF/AFL for <1 year. In such patients, the chance of long-term success appears to be relatively high.

Authors+Show Affiliations

Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy. giuseppe.boriani@unibo.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17493088

Citation

Boriani, G, et al. "Electrical Cardioversion for Persistent Atrial Fibrillation or Atrial Flutter in Clinical Practice: Predictors of Long-term Outcome." International Journal of Clinical Practice, vol. 61, no. 5, 2007, pp. 748-56.
Boriani G, Diemberger I, Biffi M, et al. Electrical cardioversion for persistent atrial fibrillation or atrial flutter in clinical practice: predictors of long-term outcome. Int J Clin Pract. 2007;61(5):748-56.
Boriani, G., Diemberger, I., Biffi, M., Domenichini, G., Martignani, C., Valzania, C., & Branzi, A. (2007). Electrical cardioversion for persistent atrial fibrillation or atrial flutter in clinical practice: predictors of long-term outcome. International Journal of Clinical Practice, 61(5), 748-56.
Boriani G, et al. Electrical Cardioversion for Persistent Atrial Fibrillation or Atrial Flutter in Clinical Practice: Predictors of Long-term Outcome. Int J Clin Pract. 2007;61(5):748-56. PubMed PMID: 17493088.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Electrical cardioversion for persistent atrial fibrillation or atrial flutter in clinical practice: predictors of long-term outcome. AU - Boriani,G, AU - Diemberger,I, AU - Biffi,M, AU - Domenichini,G, AU - Martignani,C, AU - Valzania,C, AU - Branzi,A, PY - 2007/5/12/pubmed PY - 2007/8/25/medline PY - 2007/5/12/entrez SP - 748 EP - 56 JF - International journal of clinical practice JO - Int J Clin Pract VL - 61 IS - 5 N2 - Despite the results of Atrial Fibrillation Follow-up Investigation of Rhythm Management and Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation trials, which favour a general shift in atrial fibrillation (AF) therapeutic approach towards control of ventricular rate, a strategy based on restoration of sinus rhythm could still play a role in selected patients at lower risk of AF recurrence. We explored possible predictors of relapses after external electrical cardioversion among patients with persistent AF or atrial flutter (AFL). We analysed the clinical characteristics and conventional echocardiographic parameters of patients with persistent AF/AFL enrolled in an institutional electrical cardioversion programme. Among 242 patients (AF/AFL, 195/47; mean age 62+/-13 years), sinus rhythm was restored in 215 (89%) and maintained in 73 (34%) at a follow-up of 930 days (median). No baseline clinical/echocardiographic variables predicted acute efficacy of cardioversion at logistic regression analysis. However, two variables predicted long-term AF/AFL recurrence among patients with successful cardioversion at multivariate Cox's proportional hazards analysis: (i) duration of arrhythmia>or=1 year (HR, 2.07; 95% CI, 1.29-3.33) and (ii) presence of previous cardioversion (HR, 1.67; 95% CI, 1.17-2.38). These variables also presented high-positive predictive values (72% and 80% respectively). Whereas the high acute efficacy of electrical cardioversion (approximately 90%) does not appear to be predictable, two simple clinical variables could help identify patients at higher risk of long-term AF/AFL recurrence after successful electrical cardioversion. We think there could be a case for initially attempting external electrical cardioversion to patients who have had AF/AFL for <1 year. In such patients, the chance of long-term success appears to be relatively high. SN - 1368-5031 UR - https://www.unboundmedicine.com/medline/citation/17493088/Electrical_cardioversion_for_persistent_atrial_fibrillation_or_atrial_flutter_in_clinical_practice:_predictors_of_long_term_outcome_ L2 - https://doi.org/10.1111/j.1742-1241.2007.01298.x DB - PRIME DP - Unbound Medicine ER -