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A review of direct current cardioversions for atrial arrhythmia
S D Johnston1, T G Trouton, C Wilson
1Department of Medicine, Institute of Clinical Science, Royal Victoria Hospital, Belfast.
Insights
Direct Current Cardioversion (DCC) for atrial fibrillation carries an arterial embolism risk. Prophylactic anticoagulation should be considered for all patients undergoing DCC, as embolic complications can occur even with normal echocardiographic findings.
Area of Science:
- Cardiology
- Electrophysiology
- Vascular Medicine
Background:
- Arterial embolism risk is recognized after Direct Current Cardioversion (DCC) for atrial fibrillation.
- The necessity and efficacy of prophylactic anticoagulation remain debated.
Purpose of the Study:
- To assess the risk of arterial embolism following cardioversion.
- To identify factors predicting successful cardioversion and sustained sinus rhythm.
Main Methods:
- Retrospective study of 157 cardioversions for atrial fibrillation/flutter (1989-1993).
- Review of medical records and ECGs for patient demographics, comorbidities, anticoagulation status, echocardiographic features, and arrhythmia characteristics.
- Monitoring for embolic events within six weeks post-cardioversion.
Main Results:
- Three out of 109 patients (2.7%) experienced embolic complications; none were on pre-procedure anticoagulation.
- Successful return to sinus rhythm in 143 procedures (91%).
- Increasing atrial fibrillation coarseness showed a trend towards successful cardioversion (p=0.18) and predicted arrhythmia recurrence (p<0.05).
Conclusions:
- Embolic complications are possible post-DCC, even with normal echocardiographic dimensions.
- Prophylactic anticoagulation warrants consideration for all patients undergoing DCC.
- Atrial fibrillation coarseness may predict cardioversion success and rhythm maintenance.
Unlabelled:
The risk of arterial embolism is well recognised following Direct Current Cardioversion (DCC) for atrial fibrillation although the use of prophylactic anticoagulation remains controversial.
Aim:
To determine the risk of arterial embolism post-cardioversion and which factors predict successful cardioversion and maintenance of sinus rhythm.
Materials And Methods:
A retrospective study was carried out of all cardioversions performed for atrial fibrillation and atrial flutter at the Waveney Hospital Ballymena, during 1989-1993. A review of medical records and electrocardiograms was carried out to assess demographic characteristics, co-existent diseases, anticoagulant status, echocardiographic features and characteristics of the arrhythmia. Embolic events in the six weeks post-cardioversion were noted.
Results:
The study included 157 cardioversions in 109 patients. The predominant arrhythmia was atrial fibrillation (n = 108, 69%). Three of 109 patients (2.7%) experienced embolic complications, none of whom had anticoagulation prior to the procedure. No risk factors for cerebro-vascular disease or significant valvular heart disease were present. Return to sinus rhythm was achieved in 143 (91%) procedures. Increasing coarseness of atrial fibrillation was associated with a non-significant trend towards successful restoration of sinus rhythm (p = 0.18). Recurrence of the original arrhythmia was predicted by an increase in coarseness of atrial fibrillation (p < 0.05).
Conclusions:
These findings indicate that embolic complications can occur in patients undergoing DCC with normal echocardiographic dimensions, and that prophylactic anticoagulation should be considered in all patients. Coarseness of atrial fibrillation may be used as a guide to predict the chance of successful cardioversion and of the likelihood of maintaining sinus rhythm once this has been achieved.