| Literature DB >> 20003371 |
Suman S Kuppahally1, Elyse Foster, Stanford Shoor, Anthony E Steimle.
Abstract
BACKGROUND: Initial success of electrical cardioversion (ECV) of atrial fibrillation (AF) has been reported in several studies as 50%-90%, of which only 50% patients remain in sinus rhythm (SR) at the end of one year. We conducted this study to see if outcomes of other trials are applicable in managed care setting.Entities:
Year: 2009 PMID: 20003371 PMCID: PMC2800107 DOI: 10.1186/1755-7682-2-39
Source DB: PubMed Journal: Int Arch Med ISSN: 1755-7682
Characteristics of patients who underwent electrical cardioversion for atrial fibrillation
| Total number of patients | 370 |
|---|---|
| Age of patients (mean ± SD years) | 67 +/- 12 |
| ≤ 65 years | 137 |
| >65 years | 233 |
| Men/Women | 239/131 |
| Coronary artery disease | 150 |
| Congestive heart failure | 116 |
| Mitral stenosis | 16 |
| Mitral regurgitation | 92 |
| Paroxysmal atrial fibrillation | 196 |
| Hypertension | 185 |
| Cardiomyopathy | 75 |
| Diabetes mellitus | 46 |
| Chronic obstructive pulmonary disease | 51 |
| Alcoholism | 105 |
| Smoking | 96 |
| Lone atrial fibrillation | 27 |
| Duration of atrial fibrillation | |
| 0-3 days | 91 |
| 4 days-3 months | 105 |
| >3 months | 174 |
| Left atrial size (157 patients) | |
| ≤ 4.2 cm | 72 |
| >4.2 cm | 85 |
| Left Ventricular Ejection Fraction | |
| Normal | 129 |
| Reduced | 40 |
Figure 1Results of serial electrical cardioversion in atrial fibrillation and follow-up over one year. (ECV-Electrical cardioversion, AF-atrial fibrillation).
Outcome of electrical cardioversion in atrial fibrillation on prophylactic antiarrhythmic treatment before the 1st and 2nd electrical cardioversion
| Antiarrhythmic drug | Patients with successful 1st ECV (%) | Patients with successful 2nd ECV (%) |
|---|---|---|
| Procainamide | 22 (73) | 5 (71) |
| Amiodarone | 15 (75) | 17 (59) |
| Quinidine | 9 (75) | 2 (100) |
| Ibutilide | 6 (75) | 4 (100) |
| Propafenone | 6 (86) | 3 (100) |
| Sotalol | 6 (86) | 17 (94) |
| Flecainide | 1 (50) | 2 (67) |
| No drug | 178 (63) | 22 (79) |
Co-morbidities affecting success of initial electrical cardioversion (logistic regression)
| Parameter | p-value | Odds Ratio Estimates | |
|---|---|---|---|
| Age: ≤ 65 and > 65 years | 0.532 | 0.519 | 1.404 |
| Sex: Male vs. Female | 0.086 | 0.939 | 2.578 |
| Duration: ≤ 3 m vs. > 3 months | 0.006 | 0.332 | 0.837 |
| Duration: 0-3 days vs. > 3 months | 0.003 | 1.361 | 4.693 |
| Duration: 4 days-3 m vs. > 3 months | 0.113 | 0.902 | 2.655 |
| On antiarrhythmic medications | 0.032 | 1.056 | 3.420 |
| Lone atrial fibrillation | 0.736 | 0.325 | 2.215 |
| Congestive heart failure | 0.406 | 0.437 | 1.398 |
| Cardiomyopathy | 0.968 | 0.531 | 1.934 |
| Mitral stenosis | 0.517 | 0.393 | 6.390 |
| Mitral regurgitation | 0.684 | 0.612 | 2.111 |
| Pulmonary Disease | 0.533 | 0.372 | 1.669 |
| Diabetes mellitus | 0.070 | 0.942 | 4.525 |
| Coronary artery disease | 0.414 | 0.744 | 2.049 |
| Hypertension | 0.867 | 0.592 | 1.556 |
| Paroxysmal atrial fibrillation | 0.498 | 0.726 | 1.932 |
| Alcoholism | 0.173 | 0.410 | 1.175 |
| Smoking | 0.682 | 0.617 | 0.092 |
Figure 2Results of serial electrical cardioversion in atrial fibrillation in patients after prophylactic antiarrhythmic drugs and follow-up over one year. (ECV-Electrical cardioversion, AF- atrial fibrillation).
Co-morbidities affecting recurrence of atrial fibrillation after a successful electrical cardioversion (logistic regression)
| Parameter | p-value | Odds Ratio Estimates | |
|---|---|---|---|
| Age: ≤ 65 vs. > 65 years | 0.019 | 1.136 | 4.424 |
| Sex: Male vs. Female | 0.815 | 0.536 | 2.205 |
| Duration: 0-3 days vs. > 3 months | 0.607 | 0.380 | 1.759 |
| Duration: 4 days-3 m vs. > 3 months | 0.692 | 0.539 | 2.535 |
| On antiarrhythmic medication | 0.948 | 0.475 | 2.006 |
| Lone atrial fibrillation | 0.405 | 0.089 | 2.661 |
| Congestive heart failure | 0.884 | 0.413 | 2.142 |
| Cardiomyopathy | 0.885 | 0.373 | 2.343 |
| Mitral stenosis | 0.422 | 0.429 | 7.533 |
| Mitral regurgitation | 0.293 | 0.277 | 1.473 |
| Pulmonary Disease | 0.540 | 0.209 | 2.270 |
| Diabetes mellitus | 0.061 | 0.124 | 1.048 |
| Coronary artery disease | 0.760 | 0.570 | 2.158 |
| Hypertension | 0.904 | 0.500 | 1.848 |
| Paroxysmal atrial fibrillation | 0.009 | 1.257 | 5.149 |
| Alcoholism | 0.007 | 1.306 | 5.627 |
| Smoking | 0.099 | 0.183 | 1.157 |
Figure 3Effect of duration on the success of electrical cardioversion in atrial fibrillation.