NEW YORK (Reuters Health) – While initial success rates of electrical cardioversion for atrial fibrillation/flutter are high, only a minority of patients maintain sinus rhythm in the long term. The finding suggests that stopping anticoagulation therapy in cardioverted patients at 1 month is unsafe.
"There is currently considerable debate with regard to the optimal management of atrial fibrillation/flutter (AF), including the long-term success of electrical cardioversion and the duration of anticoagulation thereafter," Dr. Colin Berry, of Western Infirmary, Glasgow, UK, and colleagues note in a report in the November issue of the International Journal of Cardiology. [
In a prospective, observational study, the researchers examined the current management and outcomes of electrical cardioversion in 111 consecutive patients with AF "in ordinary clinical practice."
Ninety-six of the patients (86%) achieved immediate sinus rhythm restoration, and 88 patients (79%) remained in sinus rhythm at discharge, according to the report. Of those 88, 54 (61%) were in sinus rhythm at 1 month and a further 21 relapsed into AF by 1 year.
"Independent predictors of sinus rhythm at discharge were younger age (for a difference of 5 years, odds ratio = 1.54; p = 0.002) and absence of hypertension (1.73; p = 0.015)," the team notes.
"The presence of sinus rhythm at discharge (6.4; p = 0.007) was an independent predictor of sinus rhythm at 1 month, whereas older age was a negative predictor (0.96; p = 0.05)." The presence of sinus rhythm at 1 month was the only predictor of sinus rhythm at 1 year (OR = 4.8; p =0.002).
The mean global health-related quality of life score at baseline was 54. The quality of life score improved at 1 and 12 months in the sinus rhythm group, with changes of 16 and 10.3, respectively, versus -4.2 and -0.7, respectively, in the AF group (p = 0.001 and p = 0.01 at 1 and 12 months, respectively).
"Further studies of the longer term (1 to 5 years) relapse rate in successfully cardioverted patients are needed, as are studies of the risk faced by patients who are restored to sinus rhythm and withdrawn from anticoagulant treatment soon after cardioversion," Dr. Berry and colleagues conclude.
Int J Cardiol 2001;81:29-35
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