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Effectiveness of a simple medication adjustment protocol for optimizing peri-cardioversion rate control: A derivation
Nelson Lu1, Jenny MacGillivray2, Jason G Andrade3
1Department of Medicine, University of British Columbia, Vancouver, Canada.
Heart Rhythm O2
|June 11, 2021
Summary
A new protocol optimizes rate control medications before direct-current cardioversion (DCCV) for atrial fibrillation (AF). This simple adjustment strategy improves heart rate control and minimizes risks like bradycardia or pacing needs.
Area of Science:
- Cardiology
- Pharmacology
- Medical Procedures
Background:
- Persistent atrial fibrillation (AF) management relies on rate control medications.
- No established guidelines exist for adjusting these medications before direct-current cardioversion (DCCV).
Purpose of the Study:
- To develop and validate a pre-DCCV medication adjustment protocol.
- To maintain optimal rate control during DCCV.
- To minimize risks such as bradycardia, pauses, pacing, and CPR post-DCCV.
Main Methods:
- A medication adjustment protocol was derived and validated in patients undergoing elective DCCV for persistent AF.
- The protocol involved adjusting atrioventricular (AV) nodal blockers based on heart rate (HR) two days prior to DCCV.
- The protocol was tested prospectively and compared against standard care.
Main Results:
- The derived protocol involved continuing, reducing, or holding AV nodal blockers based on pre-DCCV HR.
- The protocol significantly improved peri-DCCV rate control (82% vs. 62%, P < .001) in the validation cohort.
- No instances of prolonged pauses, need for pacing, or CPR were observed post-DCCV.
Conclusions:
- A simple preprocedural medication adjustment protocol effectively optimizes peri-DCCV rate control in AF patients.
- This strategy enhances procedural safety and efficacy.
- The protocol offers a practical approach for clinicians managing AF patients undergoing DCCV.
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