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106 The impact of covid-19 on amiodarone use in nottingham university hospitals dc cardioversion service; 1 year follow up
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  1. Francesca Doleman,
  2. Tim Robinson,
  3. Bhavani Kamalakannan,
  4. Catherine Odendaal
  1. Nottingham University Hospitals

Abstract

Background DC cardioversion (DCCV) is commonly used to restore sinus rhythm (SR) in patients with persistent atrial fibrillation or flutter (AF). DCCV is not always successful and often AF recurs soon after. Oral Amiodarone therapy increases the efficacy of DCCV on the day and increases duration of SR after DCCV. The NUH elective DCCV service was suspended for 6 months at the start of the COVID19 pandemic. On its resumption NUH Arrhythmia team advised that all eligible patients be commenced on oral amiodarone at the time of referral for DCCV with the aims of achieving chemical cardioversion prior to DCCV, increase on-the-day DCCV success rates, reduce volume of repeat DCCVs and reduce number of patients on the waiting list.

Methods Retrospective analysis of 576 DCCV referrals and outcomes from January 2019 until August 2021; 281 prior to March 2020 and 295 after August 2020. Patient demographics, specialty of consultant in charge of patient care, BMI, LV function, LA size, medications, chemical cardioversion rates and DCCV success rates were collected. Follow up data was collected at 3 and 12 months post DCCV where available. Propensity score matching to assess impact of amiodarone use was performed on the initial data. The follow up data was analysed using a two tailed Fishers exact test.

Results Post COVID19 suspension 46% of DCCV patients were on amiodarone vs 33% before (p = 0.001). Amiodarone use was higher in patients referred by an EP consultant (OR 1.42; 95% CI 1.01 to 1.98, p = 0.04). Propensity score matching demonstrated that patients on amiodarone were more likely to chemically cardiovert and obviate the need for DCCV (OR 1.75, 95% CI 1.06-2.89, p = 0.03).

126 patients had an AF ablation or further DCCV within 12 months of the initial DCCV. Of the remaining 450 patients follow up data was available at 3 months on 382 patients and 12 months on 238 patients. Patients taking amiodarone were more likely to maintain SR at 3 months (79% vs 63% p=0.001) and at 12 months (52% vs 27% p=0.0001).

Conclusion Increased use of Amiodarone, prompted by the C19 pandemic, increased both rates of chemical cardioversion and maintenance of SR at 3 and 12 month follow up post DCCV. This significantly reduced the waiting list time for patients needing DCCV.

Abstract 106 Table 1

3 Months

Abstract 106 Table 2

12 Months

Conflict of Interest Nil

  • Atrial Fibrillation
  • Amiodarone
  • DC Cardioversion

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