Optimal timing for cardioversion in patients with atrial fibrillation
| Autor: | Ilpo Nuotio, Tapio Hellman, Tuija Vasankari, Mika Lehto, Fausto Biancari, K.E. Airaksinen, Juha Hartikainen, Tuomas Kiviniemi |
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| Přispěvatelé: | University of Helsinki, Faculty of Medicine, Clinicum, Department of Medicine, Kardiologian yksikkö, HUS Heart and Lung Center |
| Rok vydání: | 2018 |
| Předmět: |
Male
Time Factors PREDICTION medicine.medical_treatment Management of atrial fibrillation 030204 cardiovascular system & hematology Cardioversion Electrocardiography 0302 clinical medicine Recurrence Atrial Fibrillation 030212 general & internal medicine Stroke Finland RISK COMPLICATIONS Incidence Atrial fibrillation General Medicine Middle Aged TIME Electrical cardioversion Survival Rate Treatment Outcome Cardiology Female Cardiology and Cardiovascular Medicine STROKE medicine.medical_specialty Electric Countershock Clinical Investigations Time-to-Treatment 03 medical and health sciences Internal medicine Thromboembolism medicine Humans In patient Adverse effect Success Rate Aged Retrospective Studies business.industry UNSUCCESSFUL ELECTRICAL CARDIOVERSION ta3121 medicine.disease Arrhythmic Complications Increased risk 3121 General medicine internal medicine and other clinical medicine business Follow-Up Studies |
| Zdroj: | Clinical cardiology. 41(7) |
| ISSN: | 1932-8737 |
| Popis: | 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 ( 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (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% (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. |
| Databáze: | OpenAIRE |
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