Related Experiment Video
Updated: Jul 18, 2026
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
[Therapeutic success of a prospective cardioversion protocol for persistent atrial fibrillation]
Angel M Martínez-Brotóns1, Ricardo Ruiz-Granell, Salvador Morell
1Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain. angelmmb@hotmail.com
Insights
Cardioversion successfully restored sinus rhythm in most persistent atrial fibrillation patients. However, recurrence was common within a year, but risk factors like arrhythmia duration and left ventricular dilatation can predict it.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- The optimal treatment for persistent atrial fibrillation remains undefined.
- Cardioversion is a potential therapeutic option.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of a strict cardioversion protocol for persistent atrial fibrillation.
- To identify predictors of recurrence after cardioversion.
Main Methods:
- A prospective study of 295 patients with persistent atrial fibrillation (≥1 month duration).
- Involved antiarrhythmic pretreatment (primarily amiodarone), cardioversion, and follow-up.
- Utilized a risk scoring system to stratify recurrence risk.
Main Results:
- Sinus rhythm was restored in 92.5% of patients.
- Recurrence rates were 33.5% at 1 month and 54.9% at 12 months.
- Independent predictors of recurrence included longer atrial fibrillation duration, prior cardioversion, and left ventricular dilatation.
Conclusions:
- Effective cardioversion maintained sinus rhythm for 1 year in 45.1% of patients with homogeneous antiarrhythmic pretreatment.
- Few side effects were observed.
- Clinical variables effectively predict recurrence risk.
Introduction And Objectives:
The best therapeutic approach for persistent atrial fibrillation has yet to be defined. Our aim was to investigate the effects of cardioversion in unselected patients with persistent atrial fibrillation who were treated according to a strict protocol involving pretreatment, cardioversion, and follow-up.
Methods:
Consecutive patients with persistent atrial fibrillation of at least 1 months' duration were included prospectively in a cardioversion protocol that involved standard antiarrhythmic pretreatment, with amiodarone being offered first, and follow-up.
Results:
The study included 295 patients, 87.5% of whom were taking the antiarrhythmic drug amiodarone. Sinus rhythm was restored in 92.5%, with pharmacologic cardioversion occurring in 9.5%. The recurrence rate was 33.5% in the first month and 54.9% by month 12. Antiarrhythmic treatment had to be modified in 10.8% of patients. Independent risk factors for recurrence during the first year after cardioversion were an atrial fibrillation duration greater than one year, previous cardioversion, and left ventricular dilatation. A simple risk scoring system was able to differentiate between subgroups of patients with a low, intermediate or high risk of recurrence in the first year after cardioversion.
Conclusions:
Sinus rhythm was maintained for 1 year after effective cardioversion in 45.1% of patients who received homogeneous antiarrhythmic pretreatment. There were few side effects. Recurrence can be predicted using clinical variables such as left ventricular dilatation, arrhythmia duration, and previous cardioversion.
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:25Dysrhythmias VI: Management of Dysrhythmias
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care
01:22Heart Failure VI: Adjunct Therapies
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...