University of Oulu

Hellman T, Kiviniemi T, Nuotio I, et al. Optimal timing for cardioversion in patients with atrial fibrillation. Clin Cardiol. 2018;41:966–971. https://doi.org/10.1002/clc.22986

Optimal timing for cardioversion in patients with atrial fibrillation

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Author: Hellman, Tapio1,2; Kiviniemi, Tuomas1; Nuotio, Ilpo2;
Organizations: 1Heart Center, Turku University Hospital and University of Turku, Turku, Finland
2Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
3Department of Surgery, Turku University Hospital and University of Turku, Turku, Finland
4Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
5Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
6Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe2018103039063
Language: English
Published: John Wiley & Sons, 2018
Publish Date: 2019-05-26
Description:

Abstract

Background: Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown.

Hypothesis: Timing of CV in AF is associated with risk of adverse events.

Methods: We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30‐day follow‐up.

Results: Study groups were stratified according to duration of index AF episode (<24 h, 24–48 h, 48 h–30d, and > 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (<24 h), 5.4% (24–48 h), 11.1% (48 h–30d), and 13.9% (>30d), respectively (P < 0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30‐day follow‐up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (<24 h), 26.5% (24–48 h), 37.3% (48 h–30d), and 30.3% (>30d), respectively (P < 0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28–1.74, P < 0.01) in multivariate analysis.

Conclusions: Optimal timing of CV for AF showed a J‐shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm‐control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.

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Series: Clinical cardiology
ISSN: 0160-9289
ISSN-E: 1932-8737
ISSN-L: 0160-9289
Volume: 41
Issue: 7
Pages: 966 - 971
DOI: 10.1002/clc.22986
OADOI: https://oadoi.org/10.1002/clc.22986
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 Internal medicine
Subjects:
Funding: This work was supported by the Finnish Foundation for Cardiovascular Research, Turku University Hospital (TYKS) Foundation, the Finnish Medical Foundation and the Finnish Medical Society Duodecim, the Finnish Cultural Foundation, and the Finnish-Norwegian Medical Foundation.
Copyright information: © 2018 Wiley Periodicals, Inc. This is the peer reviewed version of the following article: Hellman T, Kiviniemi T, Nuotio I, et al. Optimal timing for cardioversion in patients with atrial fibrillation. Clin Cardiol. 2018;41:966–971. https://doi.org/10.1002/clc.22986, which has been published in final form at https://doi.org/10.1002/clc.22986. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.