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Persistent atrial fibrillation: a population based study of patients with their first cardioversion
1Department of Medicine, Maria Hospital, Helsinki University Hospital, 00290 Helsinki, Finland. mika.lehto@fimnet.fi
Insights
Electrical cardioversion for atrial fibrillation (AF) often leads to relapse. Early treatment improves sinus rhythm maintenance, but many patients accept permanent AF within a year despite anti-arrhythmic medication.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Electrical cardioversion is effective for atrial fibrillation (AF) but long-term relapse data are limited.
- Real-world clinical practice data on cardioversion success for persistent AF is scarce.
Purpose of the Study:
- To evaluate the long-term success of electrical cardioversion in maintaining sinus rhythm for patients with persistent atrial fibrillation.
- To assess the rate of sinus rhythm restoration and maintenance, and the acceptance of permanent AF in a real-world clinical setting.
Main Methods:
- A population-based cohort study of 183 patients with persistent AF undergoing first elective electrical cardioversion.
- Follow-up assessed sinus rhythm maintenance and acceptance of permanent AF over 1 year.
- Analysis considered patient demographics, comorbidities, and time from AF diagnosis to cardioversion.
Main Results:
- Sinus rhythm was restored in 84% of patients, but only 25% maintained it for 1 year, despite 71% receiving anti-arrhythmic medication.
- Earlier cardioversion (median delay 78 days) was associated with better outcomes.
- Nearly half (40%) of patients accepted permanent AF within the follow-up year.
Conclusions:
- Persistent atrial fibrillation (AF) carries a high risk of relapse or remaining in AF, even with anti-arrhythmic medication post-cardioversion.
- A shorter duration of AF prior to cardioversion is linked to improved outcomes.
- Acceptance of permanent AF is a common outcome within one year of initial cardioversion.
Background:
Electrical cardioversion is effective in terminating even long standing atrial fibrillation (AF), but the relapse risk of AF is high. Data on long-term success of cardioversion in real life clinical practice are scant.
Methods:
Restoration and maintenance of sinus rhythm as well as acceptance of permanent AF was studied in a population based cohort (catchment area with a population of 440,000) of patients with persistent AF after first elective cardioversion.
Results:
Of the 183 patients having their first electrical cardioversion during the 1-year study period, sinus rhythm was restored in 153 patients (84%). Only 39 of these (25%) maintained sinus rhythm for 1 year, even though 108 (71%) patients had anti-arrhythmic medication. Age, hypertension, coronary artery disease, heart failure and valvular disease, or absence of these known risk factors for AF were not associated with the outcome. The outcome was better if the cardioversion was performed earlier than the median delay (78 days) from the diagnosis of AF to cardioversion compared to longer delay (P=0.022 in multivariate modelling). The decision of acceptance of permanent AF was made in 74 cases (40%) during 1 year of follow-up.
Conclusions:
Patients with persistent AF had a high tendency to remain in or relapse into AF, even though most patients had anti-arrhythmic medication after first cardioversion. Short history of arrhythmia was associated with better outcome. Acceptance of permanent AF was made in almost half of the cases during 1 year of follow-up.