Risk factors of failed electrical cardioversion in patients with persistent or long-standing persistent atrial...

Area of Science:

• Cardiology
• Electrophysiology
• Internal Medicine

Background:

• Electrical cardioversion (ECV) is a strategy for rhythm control in persistent or long-standing persistent atrial fibrillation (AF).
• Identifying predictors of ECV failure can optimize patient selection and improve treatment outcomes.

Purpose of the Study:

• To identify clinical risk factors associated with failed ECV in patients with persistent or long-standing persistent AF.
• To guide the selection of patients who are more likely to benefit from rhythm control strategies.

Main Methods:

• Retrospective review of 1058 patients undergoing ECV for persistent or long-standing persistent AF.
• Patients categorized into three groups: successful SR maintenance >1 year, successful SR maintenance ≤1 year, and failed ECV.
• Analysis of clinical characteristics, including AF duration, comorbidities, and left atrial (LA) dimensions.

Main Results:

• Failed ECV (8% of patients) was associated with longer AF duration, female sex, history of coronary artery disease (CAD) and heart failure (HF), and increased LA diameter and volume index (LAVI).
• Univariate analysis identified AF duration (≥50 months), female sex, CAD, HF, increased LA diameter (≥45 mm), increased LAVI (≥45 mL/m²), and lack of antiarrhythmic use as risk factors.
• Multivariate analysis highlighted AF duration (≥50 months), HF history, and increased LAVI as significant predictors of failed ECV.

Conclusions:

• Longer AF duration, a history of heart failure, and an increased left atrial volume index are strong predictors of failed electrical cardioversion in persistent or long-standing persistent AF.
• These factors can aid clinicians in selecting appropriate rhythm control strategies for AF patients.