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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
PubMed

Insights

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.
Abstract

Keywords:
AV nodal blockersAtrial fibrillationBradycardiaCardioversionRate control

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