Does antiarrhythmic drugs premedication improve electrical cardioversion success in persistent atrial fibrillation?

Area of Science:

• Cardiology
• Electrophysiology
• Pharmacology

Background:

• Persistent atrial fibrillation (AF) poses a significant challenge in maintaining sinus rhythm.
• Electrical cardioversion (ECV) is a common procedure for AF termination, but success rates can vary.
• The role of pre-procedural antiarrhythmic drug (AAD) administration in optimizing ECV outcomes requires further clarification.

Purpose of the Study:

• To evaluate the impact of administering antiarrhythmic drugs (AADs) for at least one month prior to electrical cardioversion (ECV).
• To assess the effect of AAD premedication on both the acute and long-term success rates of ECV in patients with persistent AF.

Main Methods:

• A multicenter study enrolled 1313 consecutive patients with persistent AF.
• Patients were divided into two groups: Group A received AADs before and after ECV; Group B received AADs only after the procedure.
• The primary endpoint was the acute and long-term restoration and maintenance of sinus rhythm.

Main Results:

• Acute ECV success was significantly higher in Group A (99%) compared to Group B (88%) (p=0.0001).
• Group A demonstrated superior long-term maintenance of sinus rhythm at one month (99% vs. 89%), one year (55% vs. 48%), and at a mean follow-up of 2.7 years (45% vs. 29%).
• AAD premedication was identified as the strongest independent predictor of both acute and long-term ECV success.

Conclusions:

• Premedication with AADs for at least four weeks before ECV significantly increases acute success rates in persistent AF.
• The positive impact of AAD administration before ECV on sinus rhythm maintenance is sustained over the long term.
• No significant differences in efficacy were observed among different types of AADs regarding acute success, shock attempts, or long-term rhythm maintenance.