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Concurrent Cardioversion of Atrial Fibrillation during ICD Shock Testing
Author(s) -
VISCHER ANNINA S.,
MUTSCHELKNAUSS MARCUS,
KÜHNE MICHAEL S.,
OSSWALD STEFAN,
STICHERLING CHRISTIAN,
SCHAER BEAT A.
Publication year - 2015
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/pace.12644
Subject(s) - medicine , cardioversion , atrial fibrillation , interquartile range , cardiology , sinus rhythm , shock (circulatory) , atrial flutter , implantable cardioverter defibrillator , amiodarone
Background Many patients receiving an implantable cardioverter‐defibrillator (ICD) also have atrial fibrillation (AF). Shock testing during ICD implantation carries a potential risk of cardioversion to sinus rhythm (SR) and thrombembolic events. We aimed to analyze the recurrence of AF after cardioversion to SR during ICD shock testing. Methods A total of 555 consecutive patients referred to a tertiary hospital in Switzerland for ICD implantation or generator exchange between 02/2002 and 03/2010 were screened for AF. Fifty‐seven patients who were in AF at the time of ICD shock testing were included. Results Forty‐four patients (77%) were successfully cardioverted from AF to SR. Type of AF (persistent, not permanent 64 vs 31% of cardioverted patients) was the only predictor. Thirty‐nine patients (89%) experienced a recurrence of AF/atrial flutter after a median of 54 days (interquartile range 35–251 days). The only predictor for recurrence of AF was previous AF declared as permanent. No ischemic stroke occurred during hospitalization for the procedure. Conclusions For patients in AF undergoing shock testing at the time of ICD implant, there is a high chance of cardioversion from AF to SR, but there is also a high risk of early recurrence. Decisions regarding long‐term anticoagulation should not be based on the heart rhythm immediately following shock testing.