Ventricular arrhythmias after atrial fibrillation electrical cardioversion: A multicenter study.

Area of Science:

• Cardiology
• Electrophysiology
• Clinical Medicine

Background:

• Ventricular arrhythmias (VAs) are a known complication following atrial fibrillation (AF) electrical cardioversion (ECV).
• Understanding the incidence, timing, and characteristics of these post-ECV VAs is crucial for patient management.

Purpose of the Study:

• To determine the incidence and timing of VAs occurring after AF ECV.
• To characterize the clinical features of patients experiencing VAs post-ECV.
• To identify risk factors associated with post-ECV VAs.

Main Methods:

• A multicenter observational retrospective study was conducted across 13 centers.
• Included patients who experienced VAs or sudden cardiac death within 10 days of AF ECV.
• Excluded patients with pre-existing VAs before ECV.

Main Results:

• The incidence of VAs post-AF ECV was 0.2% (23 out of 11,897 procedures).
• VAs occurred a median of 28.5 hours post-ECV, with 74% being Torsades de Pointes.
• Patients often had congestive heart failure (74%), hypertension (74%), and were on QT-prolonging drugs (74%). Post-ECV bradycardia and QT prolongation were noted.

Conclusions:

• Post-AF ECV VAs are rare but can be fatal, typically occurring within 3 to 72 hours.
• Prolonged monitoring is advised for a subset of patients, particularly those with congestive heart failure, on Class III antiarrhythmic drugs, and exhibiting post-ECV bradycardia or QT prolongation.