Open AccessOptimal timing for cardioversion in patients with atrial fibrillation
Author(s) -
Hellman Tapio,
Kiviniemi Tuomas,
Nuotio Ilpo,
Biancari Fausto,
Vasankari Tuija,
Hartikainen Juha,
Lehto Mika,
Airaksinen K.E.
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22986
Subject(s) - medicine , atrial fibrillation , cardioversion , adverse effect , electrical cardioversion , asystole , cardiology , anesthesia
Background Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown. Hypothesis Timing of CV in AF is associated with risk of adverse events. Methods We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30‐day follow‐up. Results Study groups were stratified according to duration of index AF episode (<24 h, 24–48 h, 48 h–30d, and > 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (<24 h), 5.4% (24–48 h), 11.1% (48 h–30d), and 13.9% (>30d), respectively ( P < 0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30‐day follow‐up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (<24 h), 26.5% (24–48 h), 37.3% (48 h–30d), and 30.3% (>30d), respectively ( P < 0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28–1.74, P < 0.01) in multivariate analysis. Conclusions Optimal timing of CV for AF showed a J‐shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm‐control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.