University of Oulu

Hellman et al. BMC Cardiovascular Disorders (2017) 17:33, DOI 10.1186/s12872-017-0470-0

Prediction of ineffective elective cardioversion of atrial fibrillation : a retrospective multi-center patient cohort study

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Author: Hellman, Tapio1; Kiviniemi, Tuomas2; Vasankari, Tuija2;
Organizations: 1Department of Medicine, Turku University Hospital and University of Turku
2Heart Center, Turku University Hospital and University of Turku
3Department of Surgery, Oulu University Hospital
4Heart Center, Kuopio University Hospital and University of Eastern Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Springer Nature, 2017
Publish Date: 2017-03-09


Background: Elective cardioversion (ECV) of atrial fibrillation (AF) is a standard procedure to restore sinus rhythm. However, predictors for ineffective ECV (failure of ECV or recurrence of AF within 30 days) are unknown.

Methods: We investigated 1998 ECVs performed for AF lasting >48 h in 1,342 patients in a retrospective multi-center study. Follow-up data were collected from 30 days after ECV.

Results: Median number of cardioversions was one per patient with a range of 1–10. Altogether 303/1998 (15.2%) ECVs failed. Long (>5 years) AF history and over 30 days duration of the index AF episode were independent predictors for ECV failure and low (<60/min) ventricular rate of AF predicted success of ECV. In patients with successful ECVs an early recurrence of AF was detected in 549 (32.4%) cases. Female gender, high (>60/min) ventricular rate, renal failure and antiarrhythmic agents at discharge were the independent predictors for recurrence. In total ECV was ineffective in 852 (42.6%) cases. Female gender (OR 1.44, CI95% 1.15–1.80, p < 0.01), young (<65 years) age (OR 1.31, CI95% 1.07–1.62, p = 0.01), ventricular rate >60/min (OR 1.92, CI95% 1.08–3.41, p = 0.03), antiarrhythmic medication at discharge (OR 1.48, CI95% 1.14–1.93, p < 0.01) and low (<60/ml/min) estimated glomerular filtration rate (OR 1.59, CI95% 1.08–2.33, p = 0.02) were predictors of ineffective ECV.

Conclusions: Female gender, use of antiarrhythmic drug therapy and renal failure predicted both recurrence of AF and the composite end point. For the first time in a large real-life study several clinical predictors for clinically ineffective ECV were identified.

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Series: BMC cardiovascular disorders
ISSN: 1471-2261
ISSN-E: 1471-2261
ISSN-L: 1471-2261
Volume: 17
Article number: 33
DOI: 10.1186/s12872-017-0470-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by the Finnish Foundation for Cardiovascular Research. The funding body did not participate in the design of the study; collection, analysis, or interpretation of data; or writing of the manuscript.
Dataset Reference: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Copyright information: © The Author(s). 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.