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38 Efficacy of DC cardioversion for atrial fibrillation: a large retrospective observational study
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  1. Alexander Carpenter,
  2. John Graby,
  3. Rachael Medland,
  4. Stewart Brown,
  5. Claire Sowerby,
  6. Louise Priestman,
  7. Mark Dayer,
  8. Guy Furniss
  1. Taunton and Somerset NHS Foundation Trust

Abstract

Introduction The evidence base for rhythm control strategies in atrial fibrillation (AF) remain contentious. Synchronised DC cardioversion (DCCV) is a simple and accessible treatment option in many centres. However, there is little data to support its use as a long-term strategy or data regarding which groups benefit most from this strategy.

Methods We collected AF cardioversion cases across a six-year period at a busy district general hospital with a nurse-led cardioversion service. Demographic, echocardiographic and procedural data were collected, as were safety and AF outcomes at 6 and 12 months. Patients with incomplete data were excluded from the analysis. Statistical analysis was undertaken using the Fischer’s exact T-test.

Results 550 cardioversion cases were included in the analysis with a median age of 67 (range 28–95). 163 (30%) of patients were obese (BMI ≥30). The mean CHA2DS2-VASc was 2.3. 342 (62%) of DCCV were for persistent AF, the remainder (208; 38%) longstanding (AF duration >1 year) persistent. 162 (29%) had an unknown duration of AF due to an incidental diagnosis. 483 (88%) were on AV-nodal blocking and 103 (19%) on anti-arrhythmic medication (flecainide, sotalol or amiodarone). 516 (94%) of DCCVs were acutely successful with a complication rate of 2% (n=13), most commonly symptomatic bradycardia requiring temporary transcutaneous (n=2) or percussion pacing (n=6) with no acute strokes. At 1 year 5 (0.9%) had had a stroke/transient ischaemic attack and 9 (1.6%) died. 179/478 (37%) of patients were free from AF at 6 months, with 100/412 (24%) free from AF at 1 year. 89 (16%) of patients were referred for further cardioversion and 144 (26%) referred for catheter ablation. There was no statistically significant effect of patient age, obesity, left ventricular (LV) impairment, or left atrial (LA) dilatation on 6-month outcomes. However, AF duration <1 year did correlate with statistically significant improvement in 6 month freedom from AF (41% vs 31%, p=0.03). In those with moderate/severe LV impairment, anti-arrhythmic use significantly improved 6-month outcomes (70% vs 40%, p=0.01). However, no such effect was seen between moderate/severely dilated and non-dilated LA.

Conclusion DCCV for AF remains a safe procedure with good acute success rates. However, within 6 months the majority of patients will have reverted to AF. AF duration of less than 1 year is associated with an improved 6-month success rate, as does antiarrhythmic use in those with impaired LV function. In selected patients, DCCV remains a useful tool as a ‘trial of sinus rhythm’ to establish potential symptomatic benefits from pursuing a rhythm control strategy.

Conflict of Interest Nil

  • Nurse-led
  • Atrial fibrillation
  • Cardioversion

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