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. 2020 Jun;50(6):511-523.
doi: 10.4070/kcj.2019.0310. Epub 2020 Mar 12.

Efficacy and Safety of Outpatient Clinic-based Elective External Electrical Cardioversion in Patients with Atrial Fibrillation

Nguyen Khac Le Son  1 , Je Wook Park  1 , Min Kim  1 , Song Yi Yang  1 , Hee Tae Yu  1 , Tae Hoon Kim  1 , Jae Sun Uhm  1 , Boyoung Joung  1 , Moon Hyoung Lee  1 , Hui Nam Pak  2
Affiliations

Efficacy and Safety of Outpatient Clinic-based Elective External Electrical Cardioversion in Patients with Atrial Fibrillation

Nguyen Khac Le Son et al. Korean Circ J. 2020 Jun.

Abstract

Background and objectives: Little is known about the outcomes of outpatient clinic-based elective external cardioversion (OPC-ECV) for persistent atrial fibrillation (PeAF). We investigated the acute, short-term, and long-term elective external cardioversion (ECV) outcomes.

Methods: We included 1,718 patients who underwent OPC-ECV (74% male, 61.1±11.0 years old, 90.9% long-standing PeAF, 9.1% after atrial fibrillation [AF] ablation) after excluding patients with atrial tachycardia or inappropriate antiarrhythmic drug medication, and in-patient ECV. Biphasic shocks were delivered sequentially until successful cardioversion was achieved (70-100-150-200-250 J). If ECV failed at 150 J, we administered intravenous amiodarone 150 mg and delivered 200 J.

Results: ECV failed in 11.4%, and the complication rate was 0.47%. Within 3 months, AF recurred in 55.5% (44.7% as sustaining AF, 10.8% as paroxysmal AF), and the AF duration was independently associated (odds ratio [OR], 1.01 [1.00-1.02]; p=0.006), but amiodarone was independently protective (OR, 0.46 [0.27-0.76]; p=0.002, Log rank p<0.001) against an early recurrence. Regarding the long-term recurrence, pre-ECV heart failure was protective against an AF recurrence (hazard ratio, 0.63 [0.41-0.96], p=0.033) over 32 (9-66) months of follow-up. ECV energy (p<0.001) and early recurrence rate within 3 months (p=0.007, Log rank p=0.006) were significantly lower in post-ablation patients than in those with long-standing persistent AF.

Conclusions: The success rate of OPC-ECV was 88.6%, and the complication rate was low. However, AF recurred in 55.5% within 3 months. Amiodarone was protective against short-term AF recurrences, and long-term AF recurrences were less in patients with baseline heart failure.

Keywords: Atrial fibrillation; Cardioversion; Recurrence.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Flowchart of including, excluding and dividing PeAF patients into 2 groups: L-PeAF and post-AFCA.
AAD = antiarrhythmic drug; AF = atrial fibrillation; AFCA = atrial fibrillation catheter ablation; AT = atrial tachycardia; ECG = electrocardiogram; ECV = elective external cardioversion; L-PeAF = long-standing persistent atrial fibrillation; PAF = paroxysmal atrial fibrillation; PeAF = persistent atrial fibrillation.
Figure 2
Figure 2. Kaplan-Meier curves for AF recurrence-free survival rate in short-term (above) and long-term (beneath) follow-up after successful ECV between groups L-PeAF, heart failure, amiodarone (red line) and post-AFCA, non heart failure, non-amiodarone (blue line).
AF = atrial fibrillation; AFCA = atrial fibrillation catheter ablation; ECV = elective external cardioversion; L-PeAF = long-standing persistent atrial fibrillation; PeAF = persistent atrial fibrillation.
See this image and copyright information in PMC

References

    1. Kim D, Yang PS, Jang E, et al. 10-year nationwide trends of the incidence, prevalence, and adverse outcomes of non-valvular atrial fibrillation nationwide health insurance data covering the entire Korean population. Am Heart J. 2018;202:20–26. - PubMed
    1. Marrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417–427. - PubMed
    1. Packer DL, Mark DB, Robb RA, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321:1261–1274. - PMC - PubMed
    1. Mansour M, Heist EK, Agarwal R, et al. Stroke and cardiovascular events after ablation or antiarrhythmic drugs for treatment of patients with atrial fibrillation. Am J Cardiol. 2018;121:1192–1199. - PubMed
    1. Jin MN, Kim TH, Kang KW, et al. Atrial fibrillation catheter ablation improves 1-year follow-up cognitive function, especially in patients with impaired cognitive function. Circ Arrhythm Electrophysiol. 2019;12:e007197. - PubMed