Abstract 13340: Contemporary Use and Clinical Outcomes Following Non-Emergent Electrical Cardioversion for Atrial Fibrillation
Background: Electrical cardioversion (ECV) is recommended as one means of rhythm control for patients with atrial arrhythmias. However, the use of and outcomes following ECV in practice are not well described.
Methods: We reviewed all, non-emergent ECVs for atrial arrhythmias at a tertiary care center from 2010 through 2013. Patients were stratified by use of TEE prior to ECV and demographics, history, vitals, and laboratory studies were compared. Outcomes included immediate ECV success, complications, repeat cardioversion, rehospitalization, and death at 30 days.
Results: Overall 1,017 patients underwent ECV during the study period, most for atrial fibrillation (n=760, 75%) or atrial flutter (n=240, 24%); 633 underwent TEE prior to ECV and 384 did not. Those who had a TEE were more likely to be inpatients (74% vs. 44%, p<0.001), had higher mean CHADS2 scores (2.6 vs. 2.4, p=0.03), and lower INRs (mean 1.2 vs. 2.1, p<0.001). Overall, 8.8% (n=89) did not achieve sinus rhythm and there were 14 immediate complications (1.4%); 7.9% (n=80) underwent repeat cardioversion within 30 days. There were 113 (re)hospitalization events (11%) and 14 patients died (1.4%) within 30 days. Although successful conversion to sinus rhythm was significantly more common in patients who underwent cardioversion with TEE (77% vs. 68%, p=0.01), there was no difference in Kaplan-Meier rates of death or rehospitalization within 30 days (11.1% vs. 13.0%, p=0.37). In multivariable analyses, pre-cardioversion higher heart rate was associated with increased (re)hospitalization or death (adjusted HR 1.15 per 10 bpm, 95% CI 1.07-1.24, p<0.001), while use of TEE was associated with lower rates (adjusted HR 0.58, 95% CI 0.39-0.86, p=0.007).
Conclusions: Failures, complications, and rehospitalization following non-emergent ECV for AF are relatively common. Adverse events are associated more with patient condition than procedural characteristics.
Author Disclosures: B.A. Steinberg: Other Research Support; Modest; Janssen, Boston Scientific. Other; Modest; Medtronic. P. Schulte: None. P. Hofmann: None. M. Ersboll: None. J.H. Alexander: Research Grant; Significant; Bristol Myers Squibb, Boehringer Ingelheim, CLS Behring, NIH, Oxygen Biotherapeutics, Perosphere, Regado Biosciences, Vivus Pharmaceuticals. Consultant/Advisory Board; Modest; Portola, Regado Biosciences, Bristol Myers Squibb. K. Broderick-Forsgren: None. K.J. Anstrom: None. C.B. Granger: Research Grant; Significant; Bristol Myers Squibb, Boehringer Ingelheim, Glaxo SmithKline, Medtronic, Merck & Co., Pfizer, Sanofi-Aventis, Takeda, The Medicines Company, Daiichi Sankyo. Consultant/Advisory Board; Modest; Eli Lilly, Boehringer Ingelheim, Glaxo SmithKline, Hoffmann-La Roche, Sanofi-Aventis, Takeda, The Medicines Company, AstraZeneca, Ross Medical Corporation, Daiichi Sankyo, Pfizer. Consultant/Advisory Board; Significant; Bristol Myers Squibb. J.P. Piccini: Research Grant; Significant; Janssen, ARCA Biopharma. E.J. Velazquez: Research Grant; Significant; Abbott Laboratories, Ikaria. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Gilead, Novartis. B.R. Shah: Research Grant; Significant; Amgen, Amylin, Glaxo SmithKline, Lilly, Roche. Consultant/Advisory Board; Modest; Bristol Myers Squibb, Cardinal, Castlight, Janssen.
- © 2014 by American Heart Association, Inc.