Korean Circ J.  2020 Jun;50(6):511-523. 10.4070/kcj.2019.0310.

Efficacy and Safety of Outpatient Clinic-based Elective External Electrical Cardioversion in Patients with Atrial Fibrillation

• Son NKL
• Park JW
• Kim M
• Yang SY
• Yu HT
• Kim TH
• Uhm JS
• Joung B
• Lee MH
• Pak HN

• KMID: 2500943
• DOI: http://doi.org/10.4070/kcj.2019.0310

Abstract

Background and Objectives
Little is known about the outcomes of outpatient clinic-based elective external cardioversion (OPC-ECV) for persistent atrial fibrillation (PeAF). We investigated the acute, short-term, and long-term elective external cardioversion (ECV) outcomes.
Methods
We included 1,718 patients who underwent OPC-ECV (74% male, 61.1±11.0 years old, 90.9% long-standing PeAF, 9.1% after atrial fibrillation [AF] ablation) after excluding patients with atrial tachycardia or inappropriate antiarrhythmic drug medication, and in-patient ECV. Biphasic shocks were delivered sequentially until successful cardioversion was achieved (70-100-150-200-250 J). If ECV failed at 150 J, we administered intravenous amiodarone 150 mg and delivered 200 J.
Results
ECV failed in 11.4%, and the complication rate was 0.47%. Within 3 months, AF recurred in 55.5% (44.7% as sustaining AF, 10.8% as paroxysmal AF), and the AF duration was independently associated (odds ratio [OR], 1.01 [1.00–1.02]; p=0.006), but amiodarone was independently protective (OR, 0.46 [0.27–0.76]; p=0.002, Log rank p<0.001) against an early recurrence. Regarding the long-term recurrence, pre-ECV heart failure was protective against an AF recurrence (hazard ratio, 0.63 [0.41–0.96], p=0.033) over 32 (9–66) months of follow-up. ECV energy (p<0.001) and early recurrence rate within 3 months (p=0.007, Log rank p=0.006) were significantly lower in post-ablation patients than in those with long-standing persistent AF.
Conclusions
The success rate of OPC-ECV was 88.6%, and the complication rate was low. However, AF recurred in 55.5% within 3 months. Amiodarone was protective against short-term AF recurrences, and long-term AF recurrences were less in patients with baseline heart failure.

Keyword

Atrial fibrillation; Cardioversion; Recurrence

Figure

• 

  Figure 1 Flowchart of including, excluding and dividing PeAF patients into 2 groups: L-PeAF and post-AFCA.AAD = antiarrhythmic drug; AF = atrial fibrillation; AFCA = atrial fibrillation catheter ablation; AT = atrial tachycardia; ECG = electrocardiogram; ECV = elective external cardioversion; L-PeAF = long-standing persistent atrial fibrillation; PAF = paroxysmal atrial fibrillation; PeAF = persistent atrial fibrillation.

• 

  Figure 2 Kaplan-Meier curves for AF recurrence-free survival rate in short-term (above) and long-term (beneath) follow-up after successful ECV between groups L-PeAF, heart failure, amiodarone (red line) and post-AFCA, non heart failure, non-amiodarone (blue line).AF = atrial fibrillation; AFCA = atrial fibrillation catheter ablation; ECV = elective external cardioversion; L-PeAF = long-standing persistent atrial fibrillation; PeAF = persistent atrial fibrillation.

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