Outcomes after nonemergent electrical cardioversion for atrial arrhythmias

Area of Science:

• Cardiology
• Electrophysiology
• Medical Outcomes Research

Background:

• Electrical cardioversion (ECV) is a key treatment for atrial arrhythmias.
• Contemporary data on ECV utilization and outcomes in real-world practice are limited.

Purpose of the Study:

• To evaluate the use and outcomes of nonemergent electrical cardioversion for atrial arrhythmias.
• To compare outcomes between patients who did and did not undergo transesophageal echocardiography (TEE) prior to ECV.

Main Methods:

• Retrospective review of 1,017 nonemergent ECVs for atrial arrhythmias between 2010-2013.
• Stratification of patients based on pre-ECV TEE use.
• Analysis of demographics, clinical factors, procedural success, complications, and 30-day adverse events (repeat ECV, rehospitalization, death).

Main Results:

• Overall ECV success was 89.2%; 1.4% experienced complications. Within 30 days, 7.9% required repeat ECV, 11% were rehospitalized, and 1.4% died.
• Patients undergoing TEE were more likely to be inpatients with higher CHADS2 scores.
• While TEE use correlated with higher initial ECV success (77% vs 68%), 30-day rehospitalization and death rates did not differ significantly between groups (11.1% vs 13.0%).
• Higher pre-ECV heart rate predicted increased rehospitalization/death; TEE use was associated with lower rates (aHR 0.58).

Conclusions:

• Nonemergent ECV for atrial arrhythmias frequently involves failures, complications, and 30-day adverse events.
• Patient condition, rather than procedural characteristics alone, influences outcomes.
• Transesophageal echocardiography use prior to ECV is associated with improved clinical outcomes.