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Published on: February 26, 2013
Cardiovascular Events of Electrical Cardioversion Under Optimal Anticoagulation in Atrial Fibrillation: The
Dong Geum Shin1, Iksung Cho1, Bríain ó Hartaigh2,3
1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Insights
Electrical cardioversion for atrial fibrillation (AF) is generally safe, with a low rate of acute cardiovascular events. Identifying risk factors like prior stroke or heart failure is crucial for patient safety.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Electrical cardioversion is a standard treatment for symptomatic AF.
- Large-scale data on acute cardiovascular events post-cardioversion is limited.
Purpose of the Study:
- To evaluate the incidence of acute cardiovascular events after electrical cardioversion of AF.
- To identify risk factors associated with these events.
- To assess the clinical consequences of post-cardioversion events.
Main Methods:
- 1100 patients with AF undergoing electrical cardioversion were studied.
- Events assessed included stroke, transient ischemic attack, major bleeding, and arrhythmias within 30 days.
- Risk factors and patient characteristics were analyzed.
Main Results:
- The success rate for terminating AF was 87%.
- 5 strokes and 5 major bleeding events occurred.
- History of stroke/TIA and heart failure were significant predictors of thromboembolic or bleeding events.
- 8 patients were hospitalized for bradyarrhythmia, linked to lower pre-procedure heart rate.
Conclusions:
- Electrical cardioversion is a safe procedure with an acceptable cardiovascular event rate.
- Pre-procedural risk factor assessment is vital for preventing adverse events.
- Careful consideration of patient history can mitigate risks associated with cardioversion.
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.
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