Background: Clinical trials have indicated that an active rhythm control strategy aiming at restoration of sinus rhythm in patients with atrial fibrillation (AF) is no better than a rate control strategy in terms of mortality and morbidity. To what extent restoration and maintenance of sinus rhythm per se affect long-term prognosis in AF patients is less clear.
Aim: ”To investigate if there are differences in mortality and morbidity between DC-cardioverted AF patients who remain in sinus rhythm after cardioversion and those who relapse early.”
Method: 361 cardioverted patients from the Stockholm Cohort Study on Atrial Fibrillation were studied by means of medical records and national registers. Patients were followed for a mean 4.2 years from DC cardioversion regarding all-cause mortality and for a mean 3.2 years for a composite endpoint of death, ischaemic stroke, myocardial infarction or hospitalization for heart failure.
Results: All-cause mortality tended to be lower in patients who had been successfully cardioverted and had had no known relapse of AF within the first three months after cardioversion (Hazard ratio (HR) 0.57, 95% confidence interval (CI) 0.30-1.06, p=0.076). They also had significantly lower incidence of the composite endpoint than those who relapsed early (HR 0.51, 95% C.I. 0.32-0.82, p=0.0058).
Conclusion: Restoration and three months maintenance of sinus rhythm was associated with improved long-term prognosis. The results imply that an active DC cardioversion approach is justified.
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