Adjunctive Pharmacotherapy for Elective Direct Current Cardioversion in Patients With Atrial Fibrillation

Direct current cardioversion (DCCV) can restore sinus rhythm in patients with atrial fibrillation (AF), but the long term efficacy is poor. Pharmacological therapies may improve the initial success of the procedure, but whether long term maintenance of sinus rhythm can be improved is unclear. The aim of this study was to evaluate which pharmacotherapies, including antiarrhythmic and renin-angiotensin-aldosterone system (RAAS) inhibiting drugs, most successfully promotes sinus rhythm after elective DCCV in unselected patients with atrial fibrillation.

A retrospective cohort was to study of AF patients attending or DCCV between Jan 2010 and Feb 2012. The data were analysed using multivariate logistical regression models. Initial success of DCCV was the dependent variable in the first analysis. Maintenance of sinus rhythm at follow up was the dependent variable in the second analysis.

One hundred and thirty patients were included in the first analysis, and 71 patients were included in the second analysis. The only association observed was a positive association between flecainide and an increased odds of maintaining sinus rhythm at follow up (OR 2.14, SE ± 0.93, P = 0.02) .Other antiarrhythmic drugs and RAAS inhibiting drugs had no association with an increased odds of successful DCCV or maintenance of sinus rhythm thereafter.

This is the first study to demonstrate an association between flecainide and a increased odds of maintaining sinus rhythm after DCCV in the long term. This warrants further research, and should be taken into account when choosing adjunctive antiarrhythmic therapy for elective DCCV for AF.