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