Yonsei Med J.  2015 Nov;56(6):1552-1558. 10.3349/ymj.2015.56.6.1552.

Cardiovascular Events of Electrical Cardioversion Under Optimal Anticoagulation in Atrial Fibrillation: The Multicenter Analysis

• Shin DG
• Cho I
• Hartaigh B
• Mun HS
• Lee HY
• Hwang ES
• Park JK
• Uhm JS
• Pak HN
• Lee MH
• Joung B

• KMID: 2345882
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1552

Abstract

PURPOSE
Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale study about the acute cardiovascular events following electrical cardioversion of AF is lacking. This study was performed to evaluate the incidence, risk factors, and clinical consequences of acute cardiovascular events following electrical cardioversion of AF.
MATERIALS AND METHODS
The study enrolled 1100 AF patients (mean age 60+/-11 years) who received cardioversion at four tertiary hospitals. Hospitalizations for stroke/transient ischemic attack, major bleedings, and arrhythmic events during 30 days post electric cardioversion were assessed.
RESULTS
The mean duration of anticoagulation before cardioversion was 95.8+/-51.6 days. The mean International Normalized Ratio at the time of cardioversion was 2.4+/-0.9. The antiarrhythmic drugs at the time of cardioversion were class I (45%), amiodarone (40%), beta-blocker (53%), calcium-channel blocker (21%), and other medication (11%). The success rate of terminating AF via cardioversion was 87% (n=947). Following cardioversion, 5 strokes and 5 major bleedings occurred. The history of stroke/transient ischemic attack (OR 6.23, 95% CI 1.69-22.90) and heart failure (OR 6.40, 95% CI 1.77-23.14) were among predictors of thromboembolic or bleeding events. Eight patients were hospitalized for bradyarrhythmia. These patients were more likely to have had a lower heart rate prior to the procedure (p=0.045). Consequently, 3 of these patients were implanted with a permanent pacemaker.
CONCLUSION
Cardioversion appears as a safe procedure with a reasonably acceptable cardiovascular event rate. However, to prevent the cardiovascular events, several risk factors should be considered before cardioversion.

Keyword

Atrial fibrillation; cardioversion; cardiovascular events; safety

MeSH Terms

Aged
Amiodarone/therapeutic use
Anti-Arrhythmia Agents/therapeutic use
Atrial Fibrillation/*complications/epidemiology/*therapy
Bradycardia/epidemiology/etiology
Cardiovascular Diseases/epidemiology/*etiology
Electric Countershock/*methods
Female
Heart Failure/epidemiology/etiology
Humans
Incidence
Male
Middle Aged
Risk Factors
Stroke/diagnosis/epidemiology/*etiology
Treatment Outcome
Amiodarone
Anti-Arrhythmia Agents

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