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Background  Transvenous electrical cardioversion (TVEC) is 1 of the main treatment options for atrial fibrillation (AF) in horses. Large‐scale studies on factors affecting success and prognosis have primarily been performed in Standardbred populations.    Hypothesis/Objectives  To determine factors affecting cardioversion success, cardioversion difficulty and recurrence in a predominant Warmblood study sample.    Animals  TVEC records of 199 horses.    Methods  Retrospective study of TVEC procedures of horses admitted for AF without severe echocardiographic abnormalities. Horse and procedural factors for success and cumulative amount of energy (≤ 600 J vs > 600 J) were determined using multivariable logistic regression. A survival analysis was performed to determine risk factors for recurrence.    Results  Two hundred and thirty‐one TVEC procedures were included, with a 94.4% success rate and 31.9% recurrence rate (51/160). Mitral regurgitation (OR 0.151, 95% CI 0.032‐0.715,  P  = .02) and AF cycle length (OR 1.05, 95% CI 1.01‐1.09,  P  = .02) were independent determinants for success. Catheter type (OR 0.154, 95% CI 0.074‐0.322,  P  < .001), previous AF episode (OR 3.10, 95% CI 1.20‐8.01,  P  = .02), tricuspid regurgitation (OR 2.54, 95% CI 1.25‐5.13,  P  = .01), and body weight (OR 1.009, 95% CI 1.003‐1.015,  P  = .004) were significantly correlated with cumulative amount of energy delivered. Significant risk factors for recurrence after a first AF episode were sex (stallion; HR 3.05, 95% CI 1.34‐6.95,  P  = .008), mitral regurgitation (HR 1.91, 95% CI 1.08‐3.38,  P  = .03), and AF duration (HR 1.001, 95% CI 1.0001‐1.0026,  P  = .04).    Conclusions and Clinical Importance  Both horse and procedural factors should be considered when assessing treatment options and prognosis in horses with AF.

Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence