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Observational Study
. 2023;148(4):347-352.
doi: 10.1159/000530304. Epub 2023 Apr 11.

Feasibility of Patient-Managed ECG Recordings to Detect the Time of Atrial Fibrillation Recurrence after Electrical Cardioversion: Results from the PRE-ELECTRIC Study

Elizabeth Lyster Andersen  1   2 , Magnar Gangås Solberg  1   2   3 , Marte Meyer Walle-Hansen  1   2 , Steve Enger  2 , Sophia Onarheim  2 , Mona Olufsen  2 , Trygve Berge  2   3 , Ingrid Elisabeth Christophersen  2   4 , Sara Reinvik Ulimoen  2 , Arnljot Tveit  1   2   3
Affiliations
Observational Study

Feasibility of Patient-Managed ECG Recordings to Detect the Time of Atrial Fibrillation Recurrence after Electrical Cardioversion: Results from the PRE-ELECTRIC Study

Elizabeth Lyster Andersen et al. Cardiology. 2023.

Abstract

Background: Electrical cardioversion (ECV) is a common procedure to terminate persistent atrial fibrillation (AF). The recurrence rate is high, and the patients often fail to recognize AF recurrence.

Objectives: The aim of the study was to evaluate the feasibility of patient-managed electrocardiography (ECG) to detect the time to AF recurrence after ECV.

Methods: PRE-ELECTRIC (predictors for recurrence of atrial fibrillation after electrical cardioversion) is a prospective, observational study. Patients ≥18 years of age scheduled for ECV of persistent AF at Bærum Hospital were eligible for inclusion in the study. Time to recurrence of AF was detected by thumb ECG, recorded twice daily and whenever experiencing symptoms. The observation period was 28 days. We defined adherence as the observed number of days with ECG recordings divided by the expected number of days with ECG recordings. Study personnel contacted the participants by phone to assess their awareness of AF recurrence after a recurrence was detected in the thumb ECG.

Results: The study enrolled 200 patients scheduled for ECV of persistent AF at Bærum Hospital between 2018 and 2022. The mean age was 66.2 ± 9.3 years, and 21.0% (42/200) were women. The most frequent comorbidities were hypertension (n = 94, 47.0%) and heart failure (n = 51, 25.5%). A total of 164 participants underwent ECV of AF. The procedure was initially successful in 90.9%, of which 50.3% had a recurrence of AF within 4 weeks. The median time to recurrence was 5 days. Among the cardioverted participants, 123 (75.0%) had no missing days of thumb ECG recording during the observation period, and 97.0% had ≤3 missing days. More than a third (37.3%) of the participants with AF recurrence were unaware of the recurrence at the time of contact. Women were older and more symptomatic than men but had similar outcomes after ECV.

Conclusions: Recurrence of AF after ECV was common. Using patient-managed thumb ECG was a feasible method to detect AF recurrence following ECV. Further studies are needed to investigate whether patient-managed ECG after ECV can optimize AF treatment.

Keywords: Atrial fibrillation; Electrical cardioversion; Electrocardiography; Recurrence.

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Conflict of interest statement

Dr. Berge has received speaker fees from Boehringer-Ingelheim, Bayer, and Pfizer/Bristol-Myers Squibb, outside of the submitted work. No other disclosures were reported.

Figures

Fig. 1.
Fig. 1.
Study participant flow chart. AF, atrial fibrillation; SR, sinus rhythm; ECV, electrical cardioversion.
Fig. 2.
Fig. 2.
Days to recurrence of AF detected in thumb ECG. Kaplan-Meier plot showing days to recurrence of AF by sex (a) and bar chart showing recurrence of AF at days after electrical cardioversion (b). Day 0 is the day for performed electrical cardioversion. Three participants had a recurrence of atrial fibrillation within the same evening as the electrical cardioversion. By day 3, 37.3% of the AF recurrences had occurred. AF, atrial fibrillation; SR, sinus rhythm.
See this image and copyright information in PMC

References

    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2020;42(5):373–498. 10.1093/eurheartj/ehaa612. - DOI - PubMed
    1. Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. . Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020;383(14):1305–16. 10.1056/NEJMoa2019422. - DOI - PubMed
    1. Eckardt L, Sehner S, Suling A, Borof K, Breithardt G, Crijns H, et al. . Attaining sinus rhythm mediates improved outcome with early rhythm control therapy of atrial fibrillation: the EAST: AFNET 4 trial. Eur Heart J. 2022 Aug 29;43(40):4127–44. 10.1093/eurheartj/ehac471. - DOI - PMC - PubMed
    1. Hellman T, Kiviniemi T, Vasankari T, Nuotio I, Biancari F, Bah A, et al. . Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study. BMC Cardiovasc Disord. 2017 Jan 18;17(1):33. 10.1186/s12872-017-0470-0. - DOI - PMC - PubMed
    1. Pluymaekers N, Dudink E, Luermans J, Meeder JG, Lenderink T, Widdershoven J, et al. . Early or delayed cardioversion in recent-onset atrial fibrillation. N Engl J Med Overseas Ed. 2019 Apr 18;380(16):1499–508. 10.1056/nejmoa1900353. - DOI - PubMed

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