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A comparison of early versus delayed elective electrical cardioversion for recurrent episodes of persistent atrial fibrillation: A multi-center study.
- Source :
-
International journal of cardiology [Int J Cardiol] 2019 Jun 01; Vol. 284, pp. 33-37. Date of Electronic Publication: 2018 Oct 25. - Publication Year :
- 2019
-
Abstract
- Background: Due to barriers to accessing timely elective electrical cardioversion (CV) for persistent AF (PeAF), we adopted a policy of instructing patients to present directly to the Emergency Department (ED) for CV.<br />Objective: We compare a strategy of Emergency CV (ED-CV) versus Elective CV (EL-CV) for treatment of symptomatic PeAF.<br />Methods: Between 2014 and 7, we evaluated 150 patients undergoing CV for PeAF. ED-CV patients were provided an AF action plan for recurrent symptoms and advised to present to ED within 36 h. EL-CV patients followed standard care, including cardiologist referral and placement on an elective hospital waiting list. Follow-up was 12 months.<br />Results: We included 75 consecutive ED-CV patients and 75 consecutive EL-CV patients. ED-CV patients had a significantly shorter median AF duration prior to CV (1 day vs 3 months; p < 0.01) and less overall AF-related symptoms at 12 months (modified EHRA symptom score ≥ 2a in 44% vs 72%; p = 0.005). Time to next AF recurrence was longer in the ED-CV group (295 ± 15 vs 245 ± 15 days; logrank p = 0.001), as was time to AF ablation referral (314 ± 13 vs 276 ± 15 days; logrank p = 0.01). Baseline LA area was similar (ED-CV 27 ± 4 cm <superscript>2</superscript> vs EL-CV 28 ± 11 cm <superscript>2</superscript> ; p = 0.67), however EL-CV had larger atria at follow-up (31 ± 8 vs 26 ± 6 cm <superscript>2</superscript> ; p = 0.01). There were no complications in either group.<br />Conclusion: ED-CV is an acceptable strategy for symptomatic PeAF. In addition to reduced time spent in AF and improved symptom scores, this strategy may also slow progression of atrial substrate & delay onset of next AF episode.<br /> (Copyright © 2018. Published by Elsevier B.V.)
- Subjects :
- Atrial Fibrillation physiopathology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Time Factors
Treatment Outcome
Atrial Fibrillation therapy
Atrial Function, Left physiology
Atrial Remodeling physiology
Electric Countershock methods
Heart Atria physiopathology
Heart Conduction System physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 284
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 30917880
- Full Text :
- https://doi.org/10.1016/j.ijcard.2018.10.068