Giovanni Luca Botto, Alessandro
Politi, Walter Bonini, Tiziana Broffoni, Roberto Bonatti, Giovanni Ferrari.
Department of Cardiology, S. Anna Hospital, Como, Italy
|
|
Aim. To define clinical variables
affecting technical and clinical success of external electrical cardioversion (EC) of
stable atrial fibrillation (AF).
Methods. We studied 240 patients (pts) (mean age 62 ± 10), NYHA
Class I-II, who consecutively experienced EC for converting stable AF to sinus rhythm
(SR). Pts without structural heart disease, or with only arterial hypertension were
137/240 (57%). Pts with arrhythmia duration > 72 hours were anticoagulated for 4 weeks
prior to TEC and for 3 weeks after it (INR range 2.0-3.0).
Results. We define EC technical failure the inability of restoration
of SR (Gr. TF, 17 pts, 7%), and EC clinical failure either early recurrence of AF within
24 hour (Gr. ECF, 20 pts, 8%), or within 1 month after successful EC (Gr. MCF, 53 pts,
22%). Within 1 year-follow-up, AF relapsed in 41 (17%) pts (Gr. LCF), and SR was in 109
(45%) pts (Gr. SR). In pts with unsuccessful EC or early AF recurrence of AF (Gr. TC +
ECF) arrhythmia duration was longer than in the other groups (146 ± 194 vs 82 ± 87, 86
± 86, 82 ± 134, respectively for Gr. MCF, Gr. LCF, and Gr. SR, p < 0.04). In Gr. SR
pts there was a lower prevalence of previous AF episode than in the other groups (37 vs
65%, 55%, and 51%, respectively for Gr. TC+ECF, Gr. MCF, and Gr. LCF, p < 0.005). SR
was present 24 hours after EC in 23/32 (62%) pts with AD „ 180 days and in 190/208 (86%)
pts with AD < 180 days (p = 0.045); SR was present 1 year after EC in 40/114 (35%) pts
with previous AF episode and in 69/126 (55%) pts without it (p = 0.002). Two pts
experienced embolic events respectively 2 and 13 days after successful EC while correctly
anticoagulated.
Conclusion. Arrhythmia duration can predict technical failure and
early recurrences of AF after successful EC, while history of previous episodes of AF can
limit long-term persistence of SR after successful EC.
|
