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Electrical Cardioversion of Persistent Atrial Fibrillation: Acute and Long‐Term Results Stratified According to Arrhythmia Duration
Author(s) -
TOSO ELISABETTA,
BLANDINO ALESSANDRO,
SARDI DAVIDE,
BATTAGLIA ALBERTO,
GARBEROGLIO LUCIA,
MICELI SALVATORE,
AZZARO GIUSEPPE,
CAPELLO ATTILIO LUCA,
GAITA FIORENZO
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2012.03453.x
Subject(s) - medicine , atrial fibrillation , cardiology , sinus rhythm , cardioversion , hazard ratio , electrical cardioversion , population , confidence interval , environmental health
Background: Current definition of persistent atrial fibrillation (PAF) enrolls a heterogeneous population with different atrial fibrillation (AF) exposure and degree of atrial substrate. Study aims were to evaluate acute and long‐term results of electrical cardioversion (ECV) and to identify temporal cutoff of previous AF exposure to reclassify PAF in subgroups with different chance of sinus rhythm (SR) maintenance.Methods: Five hundred twenty‐one patients (66% men; age 69 ± 10 years) with PAF undergoing ECV, were divided in four groups according to AF duration at the time of ECV: group A with AF ≤2 months (141 patients); group B with AF >2 and ≤4 months (176 patients); group C with AF >4 and ≤6 months (89 patients); and group D with AF >6 months and <1 year (115 patients).Results: There was no difference in term of acute success among groups (98.5% vs 97.1% vs 98.9% vs 96.5%, respectively, P = 0.95). At 5‐year follow‐up, 198 (41%) patients were in SR: 50% in group A, 44% in group B, 42% in group C, and 25% in group D (P < 0.001). At the multivariate analysis, previous ECV (hazard ratio [HR] 1.55, P < 0.001), left atrium enlargement (HR 1.39, P = 0.013), and AF duration >6 months at time of procedure (HR 1.59, P = 0.001) independently predict ECV failure.Conclusion: ECV is associated with high acute success rate and low complications rate. Long‐term results are strongly related with AF duration at time of ECV: a cutoff of >6 months helps in selecting patients that can take greater advantage of the procedure. (PACE 2012; 35:1126–1134)