Related Experiment Video
Updated: Jun 20, 2025
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Elective Direct Current Cardioversion of Atrial Fibrillation: Silent Brain Infarction and Health-Related Quality of
Peter M Andel1,2,3, Anne Hege Aamodt4,5, Jostein Gleditsch1,6
1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Insights
Elective direct current cardioversion (ECV) for atrial fibrillation (AF) may lead to silent brain infarctions, despite anticoagulation. Early AF recurrence is common, but ECV improves health-related quality of life (HRQL), especially with sustained sinus rhythm.
Area of Science:
- Cardiology
- Neurology
- Quality of Life Research
Background:
- Atrial fibrillation (AF) increases risks of stroke, dementia, and reduced health-related quality of life (HRQL).
- Elective direct current cardioversion (ECV) can restore sinus rhythm but carries a risk of thromboembolism.
- Silent brain infarctions, often asymptomatic, contribute to cognitive and functional decline.
Purpose of the Study:
- To evaluate the impact of ECV on silent brain infarctions in AF patients.
- To assess changes in HRQL following ECV.
- To investigate the association between AF recurrence and HRQL outcomes.
Main Methods:
- 46 AF patients underwent brain MRI and HRQL assessment (EuroQL-5D5L) pre- and post-ECV.
- Implantable loop recorders (ILRs) monitored early AF recurrence within 30 days.
- Anticoagulation was administered per guidelines; primary endpoint was silent brain infarction within 2 weeks post-ECV.
Main Results:
- One new silent brain infarction was detected post-ECV.
- AF recurrence was observed in 28.3% by ECG and 58.7% by ILR within 30 days.
- European Heart Rhythm Association (EHRA) symptom and EuroQL-5D5L scores improved post-ECV.
Conclusions:
- Silent brain infarctions can occur after ECV, even with anticoagulation.
- Early AF recurrence is frequent after ECV.
- ECV enhances HRQL, particularly in patients maintaining sinus rhythm.
Introduction:
Atrial fibrillation (AF) increases the risk for stroke, dementia, and impaired health-related quality of life (HRQL). Elective direct current cardioversion (ECV) is often used to restore sinus rhythm but is associated with thromboembolism. While larger strokes usually produce symptoms, subclinical ones may go unrecognized and may cause cognitive and functional decline over time. In the current study, we sought to evaluate the effects of ECV on silent brain infarctions and HRQL in patients with AF.
Methods:
Patients with AF (n = 46) underwent brain magnetic resonance imaging (MRI) and HRQL assessment using the EuroQL-5D5L questionnaire before and after ECV. Implantable loop recorders (ILRs) were used to observe the rate of early AF recurrences within the first 30 days. All patients were treated with anticoagulants according to guidelines. The primary endpoint was silent brain infarction assessed by brain MRI within the first 2 weeks after ECV. Secondary endpoints were the change in HRQL and its association with AF recurrence at follow-up and by ILR recordings.
Results:
New silent brain infarction after ECV was detected in 1 patient. At follow-up visit after 19.1 days AF recurrence was detected by 12-lead ECG in 13 patients (28.3%), whereas 27 patients (58.7%) had AF recurrence recorded by ILR within the first 30 days after ECV. European Heart Rhythm Association (EHRA) symptom score and the EuroQL-5d5L score were improved after ECV.
Conclusion:
Silent brain infarctions may occur after ECV despite anticoagulation treatment. Early AF recurrence is frequent. ECV positively affects HRQL mainly in those patients with sustained sinus rhythm at follow-up.
