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Published on: February 26, 2013
Antiarrhythmic preferences and outcomes post DC cardioversion for atrial fibrillation, an Australian rural
Martin Thomas1,2, James Elhindi3, Kanishka Kamaladasa1
1Department of Cardiology, Dubbo Base Hospital, Dubbo, New South Wales, Australia.
Insights
In rural Australia, amiodarone, sotalol, and no antiarrhythmic drugs (AAD) showed similar modest efficacy in maintaining sinus rhythm after direct current cardioversion (DCCV) for atrial fibrillation (AF). Prescribing practices varied, prioritizing safety in this setting.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Direct current cardioversion (DCCV) is a recommended treatment for symptomatic atrial fibrillation (AF).
- Antiarrhythmic drugs (AAD) are commonly prescribed post-DCCV to maintain sinus rhythm (SR).
- Limited data exists on AAD prescribing patterns and efficacy in rural Australian settings.
Purpose of the Study:
- To identify preferred AADs post-DCCV and influencing factors.
- To evaluate the efficacy of AADs in maintaining SR for 12 months post-DCCV.
Main Methods:
- Retrospective observational audit of 233 patients with non-valvular AF undergoing DCCV.
- Study conducted at a regional hospital in New South Wales, Australia (2015-2020).
- 12-month follow-up post-DCCV.
Main Results:
- Amiodarone was the most preferred AAD, followed by sotalol and flecainide.
- 35.2% of patients did not receive AAD post-DCCV.
- Amiodarone, sotalol, and no AAD demonstrated similar modest efficacy in maintaining SR (AF recurrence rates: 61.5%, 68.2%, 71.6% respectively).
- Factors influencing AAD prescription included cerebrovascular accident, pulmonary disease, smoking, and left ventricular dysfunction.
Conclusions:
- No significant difference in efficacy was observed between amiodarone, sotalol, and no AAD in maintaining SR 12 months post-DCCV.
- AAD prescribing practices in this rural setting deviate from national trends and guidelines.
- A multifaceted approach to AAD prescription is needed, prioritizing safety and considering rural healthcare challenges.
Introduction:
Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post-DCCV in rural Australia.
Objective:
The primary aim was to determine the preferred AAD post-DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR.
Design:
A retrospective observational audit of patients with non-valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015-2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12 months post-DCCV.
Results:
233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post-DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12 months post-DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p = 0.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices.
Conclusion:
The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12 months post-DCCV. Prescribing practices post-DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting.
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