Late recurrence of atrial fibrillation and flutter in patients referred for elective electrical cardioversion

Liam Toner; Helena Proimos; Timothy Scully; Jefferson Ko; Anoop Koshy; Mark Horrigan; Han S. Lim; Tina Lin; Omar Farouque

doi:10.18087/cardio.2023.1.n2145

Late recurrence of atrial fibrillation and flutter in patients referred for elective electrical cardioversion

Liam Toner, Helena Proimos, Timothy Scully, Jefferson Ko, Anoop Koshy, Mark Horrigan, Han S. Lim, Tina Lin, Omar Farouque

https://doi.org/10.18087/cardio.2023.1.n2145

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Abstract

Aim The primary aim was to ascertain long-term rates of atrial fibrillation (AF) recurrence in this all-comer patient population undergoing elective electrical cardioversion (DCR). Secondary aims included procedural DCR success, clinical predictors of long-term maintenance of sinus rhythm (SR) and AF related hospitalizations.
Material and Methods A retrospective cohort study was conducted. Consecutive patients (n=316) undergoing elective DCR were included.
Results Successful immediate reversion to SR was attained in 266 (84 %) of patients. 224 (84 %) patients were followed up for a median period of 3.5 years (IQR 2.7–4.3). Most patients (150 [67 %]) had recurrence of AF / flutter at a median time of 240 days. Clinical predictors of AF recurrence included a history of AF (HR 0.63, p=0.038) and a dilated left atrium (HR 4.13, p=0.048). Maintenance of SR was associated with fewer unplanned hospitalizations for AF (HR 3.25, p<0.01).
Conclusion There was high procedural success post DCR. However, long-term rates of AF recurrence were high, and AF recurrences were associated with increased hospitalizations. These findings underscore the importance of clinical vigilance and multi-modal management as part of a comprehensive and effective rhythm control strategy.

Keywords

Atrial Fibrillation, сardioversion