Abstract 3235: Lack of Uniformity Among Electrophysiologists in the Management of Atrial Fibrillation
Introduction: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia encountered in clinical practice and remains a major therapeutic challenge. The plethora of choices that currently exist for the arrhythmia considered to be a cardiovascular epidemic, has given rise to considerable discrepancy in treatment practices to restore and maintain sinus rhythm (SR).
Hypothesis: Thus, the aim of this study was to investigate variations in the methodology of cardioversion (CV) in patients with AF among electrophysiologists (EP).
Methods: EP listed in the American College of Cardiology directory were sent an electronic survey to assess how conversion to SR was achieved including:
primary method of CV,
preference of pharmacologic agent,
inpatient versus outpatient commencement of therapy,
designation of CV success,
parameters of electric CV, and
monitoring after reversion to SR.
Results: 1,735 EP were surveyed between March and August 2006, including 1,575 in the United States and 160 worldwide. There was a 67% response rate, including 185 US and 120 International EP. An overwhelming 70.8% convey a preference for using electrical methods as their initial choice for CV with 87% using an initial setting of 200J biphasic. 46% report utilizing antiarrythmics to prevent immediate return of AF prior to electrical CV and indicate amiodarone as the drug of choice in the US versus sotalol worldwide. Additionally, 75.1% utilize calcium channel blockers not for rate control, but rather to prevent electrical remodeling preceding CV. Next 29.7% define successful CV as one beat of SR as opposed to 22.2% after twenty four hours. Also, while many EP decline antiarrhythmic treatment post CV, 92.4% are satisfied with monitoring for a maximum of 4 hours. Overall, CV was initiated more commonly (77.3%) in an outpatient setting. In conclusion, there are significant differences in the management of AF, even among EP. It is likely that combined pharmacologic and non-pharmacologic therapies for AF may ultimately prevail. However, the prevalence of AF and the relative inefficacy of the currently available options warrant future studies to establish a universally implemented treatment paradigm for this ubiquitous arrhythmia.