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Pharmacological Cardioversion after Pre-Treatment with Antiarrythmic Drugs Prior to Electrical Cardioversion in

Amine El Amrani1, Xavier Viñolas2, Miguel Angel Arias3

  • 1Department of Cardiology, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain.

Journal of Clinical Medicine
|April 3, 2021
PubMed

Insights

Successful pharmacological cardioversion (PCV) in atrial fibrillation (AF) patients leads to better sinus rhythm (SR) maintenance than electrical cardioversion (ECV). Amiodarone and group Ic antiarrhythmic drugs (AADs) showed similar SR maintenance after PCV, but amiodarone was superior after ECV.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Persistent atrial fibrillation (AF) management often involves antiarrhythmic drugs (AADs) before electrical cardioversion (ECV).
  • The impact of cardioversion method and AAD type on maintaining sinus rhythm (SR) post-procedure is not well understood.

Purpose of the Study:

  • To investigate the relationship between the mode of cardioversion (pharmacological vs. electrical) and the type of AAD used.
  • To determine the effect of these factors on the maintenance of SR at three months in patients with persistent AF.

Main Methods:

  • Analysis of data from three national surveys of patients with persistent AF undergoing ECV.
  • Selection of patients pre-treated with amiodarone or group Ic AADs.
  • Comparison of SR maintenance rates at three months based on cardioversion success (pharmacological or electrical) and AAD type.

Main Results:

  • Successful pharmacological cardioversion (PCV) occurred in 151 of 665 patients, with higher SR maintenance (77.9%) compared to successful ECV (57.5%).
  • After PCV, amiodarone and group Ic AADs demonstrated similar SR maintenance (77.4% vs. 77.5%).
  • After ECV, amiodarone was superior to group Ic AADs in maintaining SR (61.3% vs. 43.0%).

Conclusions:

  • Successful PCV identifies a patient subgroup with a high likelihood of sustained SR.
  • Amiodarone and group Ic AADs are equally effective for SR maintenance post-PCV.
  • Amiodarone demonstrates superior efficacy over group Ic AADs for SR maintenance following ECV in persistent AF.
Abstract

Keywords:
antiarrhythmic drugsatrial fibrillationelectrical cardioversionpharmacological cardioversion

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