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Optimal timing for cardioversion in patients with atrial fibrillation.

ABSTRACT: 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 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 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.

SUBMITTER: Hellman T

PROVIDER: S-EPMC6489961 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Optimal timing for cardioversion in patients with atrial fibrillation.

Hellman Tapio T Kiviniemi Tuomas T Nuotio Ilpo I Biancari Fausto F Vasankari Tuija T Hartikainen Juha J Lehto Mika M Airaksinen K E KE

Clinical cardiology 20180723 7

<h4>Background</h4>Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown.<h4>Hypothesis</h4>Timing of CV in AF is associated with risk of adverse events.<h4>Methods</h4>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 a ...[more]

PMID: 29802625

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Project description:Atrial fibrillation (AF)-induced peripheral microcirculatory alterations have poorly been investigated. The present study aims to expand current knowledge through a beat-to-beat analysis of non-invasive finger photoplethysmography (PPG) in AF patients restoring sinus rhythm by electrical cardioversion (ECV). Continuous non-invasive arterial blood pressure and left middle finger PPG pulse oximetry waveform (POW) signals were continuously recorded before and after elective ECV of consecutive AF or atrial flutter (AFL) patients. The main metrics (mean, standard deviation, coefficient of variation), as well as a beat-to-beat analysis of the pulse pressure (PP) and POW beat-averaged value (aPOW), were computed to compare pre- and post-ECV phases. 53 patients (mean age 69 ± 8 years, 79% males) were enrolled; cardioversion was successful in restoring SR in 51 (96%) and signal post-processing was feasible in 46 (87%) patients. In front of a non-significant difference in mean PP (pre-ECV: 51.96 ± 13.25, post-ECV: 49.58 ± 10.41 mmHg; p = 0.45), mean aPOW significantly increased after SR restoration (pre-ECV: 0.39 ± 0.09, post-ECV: 0.44 ± 0.06 a.u.; p < 0.001). Moreover, at beat-to-beat analysis linear regression yielded significantly different slope (m) for the PP (RR) relationship compared to aPOW(RR) [PP(RR): 0.43 ± 0.18; aPOW(RR): 1.06 ± 0.17; p < 0.001]. Long (> 95th percentile) and short (< 5th percentile) RR intervals were significantly more irregular in the pre-ECV phases for both PP and aPOW; however, aPOW signal suffered more fluctuations compared to PP (p < 0.001 in both phases). Present findings suggest that AF-related hemodynamic alterations are more manifest at the peripheral (aPOW) rather than at the upstream macrocirculatory level (PP). Restoring sinus rhythm increases mean peripheral microvascular perfusion and decreases variability of the microvascular hemodynamic signals. Future dedicated studies are required to determine if AF-induced peripheral microvascular alterations might relate to long-term prognostic effects.

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Optimal timing for cardioversion in patients with atrial fibrillation.

Publications

Optimal timing for cardioversion in patients with atrial fibrillation.

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