Abstract 19504: Factors Predicting Sinus Rhythm in Patients Cardioverted in the X-VERT Study
Introduction: The X-VERT trial is the first large, prospective study of a novel oral anticoagulant in patients undergoing elective cardioversion. Patients were randomized to rivaroxaban (20mg or 15mg once daily if the CrCl was between 30 and 49 ml/min) or Vitamin K antagonist (VKA) at a ratio of 2:1. Patients were assigned to an early or delayed cardioversion strategy per the local investigator’s judgment.
Aim: To determine factors predictive of sustained sinus rhythm at the end of treatment (i.e. 6 weeks) after cardioversion.
Methods: Patients with non-valvular AF of >48 h or unknown duration were randomized. Univariate and multivariate analysis of logistic regressions were performed to detect potential predictors of clinically relevant variables.
Results: A total of 1504 randomized patients were scheduled for either early (872 patients, 58%) or delayed (632 patients, 42%) cardioversion. 1398/1504 (93%) patients underwent cardioversion (electrical or pharmacological) or experienced spontaneous cardioversion during the treatment period. The time intervals from randomization to their first cardioversion (electrical n=1,253, pharmacological n=29 or spontaneous n=116) were 2.7 ± 2.8 days versus 27.9 ± 10.1 days for early versus delayed cardioversion. The acute success of their first cardioversion (electrical or pharmacological) was seen in 1107/1282 (86.3%) patients. At the end of treatment visit, 794/1504 (52.8%) patients were in sinus rhythm. In the multivariate analysis early cardioversion was a strong predictor of sustained sinus rhythm (p<0.01).
Conclusions: In X-VERT, early cardioversion was predictive of sustained sinus rhythm. Shorter duration AF correlated with sinus rhythm.
Author Disclosures: M.D. Ezekowitz: Consultant/Advisory Board; Modest; Aegerion, Pozen Inc, AMGEN, Coherex. Consultant/Advisory Board; Significant; Boehringer Ingelheim, Pfizer, Sanofi, Bristol Myers Squibb, PORTOLA, Bayer, Daiichi Sankyo, Medtronics, MERCK, J&J, Gilead, Janssen Scientific Affairs. R. Cappato: Research Grant; Significant; Boston Scientific, Medtronic, St. Jude, Biosense Webster, BARD, ELA-Sorin. Speakers Bureau; Significant; Boston Scientific, Medtronic, St. Jude, Biosense Webster, BARD, Sanofi Aventis, Boehringer Ingelheim, Bayer Healthcare, Abbott. Ownership Interest; Significant; Cameron Health. Consultant/Advisory Board; Significant; Boston Scientific, Medtronic, St. Jude, Biosense Webster, ELA Sorin, Boehringer Ingelheim. Other; Significant; Medtronic, Biosense Webster, Sanofi-Aventis, Cameron Health, BARD, Bayer Healthcare, Abbott, Pfizer. A. Klein: Honoraria; Significant; Bayer Healthcare. I.L. Ming: Employment; Significant; Bayer Healthcare. M. Hemmrich: Employment; Significant; Bayer Healthcare. M. van Eickels: Employment; Significant; Bayer Healthcare. S.H. Hohnloser: None.
- © 2014 by American Heart Association, Inc.