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Long-term follow-up of direct current cardioversion after cardiac surgery with special reference to quinidine
Insights
DC cardioversion is often unsuccessful for maintaining sinus rhythm in rheumatic heart disease patients with pre-existing atrial fibrillation. However, it shows promise when atrial fibrillation develops post-surgery.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Valvular Heart Disease Management
Background:
- Chronic rheumatic valvar heart disease often leads to arrhythmias, including atrial fibrillation.
- Maintaining sinus rhythm is crucial for improving outcomes in patients with heart disease.
- The efficacy of DC cardioversion in rheumatic heart disease patients requires further investigation.
Purpose of the Study:
- To evaluate the long-term success of DC cardioversion in patients with rheumatic heart disease and atrial fibrillation.
- To assess the impact of pre-existing versus post-operative atrial fibrillation on sinus rhythm maintenance.
- To investigate the role of prophylactic quinidine in preventing relapses of atrial fibrillation.
Main Methods:
- Long-term follow-up of 119 patients who underwent DC cardioversion after corrective cardiac surgery for rheumatic heart disease.
- Analysis of sinus rhythm maintenance rates based on the timing of atrial fibrillation onset (pre-operative vs. post-operative).
- A controlled trial evaluating the efficacy of prophylactic quinidine.
Main Results:
- 83% of patients were initially converted to sinus rhythm.
- Patients with pre-operative atrial fibrillation had low rates of sustained sinus rhythm (9% at 2 years).
- Patients experiencing new-onset post-operative atrial fibrillation showed high success rates (82% maintained sinus rhythm for 2 years).
- Prophylactic quinidine did not significantly improve sinus rhythm maintenance compared to placebo.
Conclusions:
- Post-operative DC cardioversion is generally not recommended for rheumatic heart disease patients with pre-existing atrial fibrillation.
- DC cardioversion is effective for patients experiencing new-onset atrial fibrillation after cardiac surgery.
- Prophylactic quinidine offers no significant benefit in maintaining sinus rhythm post-cardioversion.
Abstract:
The results of the long-term follow-up of 119 patients who had DC cardioversion performed are described. All patients had had corrective cardiac surgery for chronic rheumatic valvar heart disease. The poor prognosis for maintenance of sinus rhythm in this type of patient is emphasized. Of the total patients, 83 per cent were converted to sinus rhythm, but relapses were common in those who had atrial fibrillation before operation. Only 40 per cent of such patients maintained sinus rhythm for 2 months, 15 per cent for 1 year, and 9 per cent for 2 years.By contrast, when atrial fibrillation occurred for the first time in the post-operative period, 82 per cent maintained sinus rhythm for 2 years after conversion.Post-operative DC cardioversion is in general not recommended for patients with rheumatic heart disease and atrial fibrillation unless atrial fibrillation occurs for the first time in the post-operative period. A controlled trial of prophylactic quinidine is reported and shows no significant increase in the number of patients remaining in sinus rhythm as compared with a control group not receiving quinidine.