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Published on: February 26, 2013
Prevalence and risk factors associated with decompensated heart failure after successful elective cardioversion for
Christina Healy1, Palwinder Sodhi1, Annabelle Barnett1
1University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Cardiology, United States of America.
Insights
Heart failure (HF) can occur after cardioversion (CV) for atrial fibrillation (AF) or atrial flutter (AFL). Key risk factors include prior HF hospitalization, high BMI, and valve disease.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias.
- Cardioversion (CV) is a procedure to restore normal heart rhythm.
- Heart failure (HF) is a potential complication after CV.
Purpose of the Study:
- To determine the incidence of heart failure (HF) after successful electrical and ablative cardioversion (CV) for atrial fibrillation (AF) and atrial flutter (AFL).
- To identify risk factors associated with the development of HF post-CV.
Main Methods:
- Retrospective cohort study involving 451 patients who underwent successful elective CV.
- Exclusion of patients with arrhythmias other than AF/AFL, alternative HF etiologies, or early arrhythmia recurrence.
- Review of medical records before and after CV to assess for new or worsening HF symptoms.
Main Results:
- 7.3% (33 of 451) of patients developed new or worsening HF symptoms while in sinus rhythm (SR) post-CV.
- HF symptoms occurred a median of 5.1 days post-CV.
- Significant risk factors for HF included prior HF hospitalization (OR 3.91), elevated BMI (OR 1.06), and valve disease (OR 2.51). Anti-arrhythmic drug (AAD) use was marginally significant (OR 2.02).
Conclusions:
- Decompensated heart failure (HF) occurs in 7.3% of patients within 30 days of successful CV for AF or AFL, despite maintaining sinus rhythm (SR).
- This incidence suggests HF post-CV may be more common than previously recognized.
- Elevated BMI, valve disease, prior HF hospitalization, and AAD use are significant predictors of HF following CV.
Study Objective:
To determine the incidence of and risk factors for HF after successful electrical and ablative cardioversion (CV) of atrial fibrillation (AF) and atrial flutter (AFL).
Design:
Retrospective cohort study.
Setting:
Single center academic institution.
Participants:
Seven hundred fifty-five patients underwent successful elective CV from July 1, 2018 to May 20, 2019. Patients presenting in arrhythmias other than AF or AFL, those who developed HF due to alternative etiologies, and those who developed arrhythmia recurrence within 30 days were excluded. Medical records of the remaining 451 patients were reviewed before and after CV.
Main Outcomes Measured:
Development of heart failure despite sinus rhythm following CV and the risk factors associated with this outcome.
Results:
Thirty-three (7.3 %) of 451 patients who met inclusion criteria for our study developed new or worsening HF symptoms while maintaining sinus rhythm (SR) after successful CV. Symptoms were reported an average of 5.1 days following CV (range 0-17 days, SD 4.71). Following a multivariate stepwise logistic regression model, prior HF hospitalization (OR 3.91, 95 % CI 1.82-8.39), BMI (OR 1.06, 95 % CI 1.02-1.11), and valve disease (OR 2.51, 95 % CI 1.12-5.60) remained significant risk factors, and anti-arrhythmic drug (AAD) use was marginally significant (OR 2.02, 95 % CI 0.95-4.31).
Conclusion:
Despite maintenance of SR, 7.3 % of patients developed decompensated HF in the 30 days following successful CV of AF or AFL, indicating this complication may be more frequent than previously believed. Predictors of HF post-CV included elevated BMI, valve disease, previous HF hospitalization, and prior AAD use.
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