Effect of early direct current cardioversion on the recurrence of atrial fibrillation in patients with persistent atrial fibrillation

Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure

Cardioversion is widely used in patients with atrial fibrillation (AF) and atrial flutter when a rhythm control strategy is pursued. We sought to summarize the current evidence on this important area of clinical management of patients with AF including electrical and pharmacological cardioversion, peri-procedural anticoagulation and thromboembolic complications, success rate, and risk factors for recurrence to give practical guidance.

Impact of emergency department management of atrial fibrillation with amiodarone on length of stay. A propensity score analysis based on the URGFAICS registry

OBJECTIVE

Amiodarone is a widely used drug in the emergency department (ED) for control of atrial fibrillation, but it has a delayed onset of action and slow metabolism, leading to longer length of ED stay. The aim of this study was to compare the length of ED stay of atrial fibrillation patients who were treated with or without amiodarone.

METHODS

We undertook a multicenter, observational, cohort study of the URGFAICS registry of older adults with atrial fibrillation who presented to five Spanish EDs and compared patients who had received amiodarone with those who had not. Afterward, we performed a propensity score matched analysis of atrial fibrillation to determine the ED length of stay related to amiodarone.

RESULTS

Of the 1199 patients included in the registry, 225 patients (18.8%) were treated with amiodarone while 974 (81.2%) were not. We performed a univariate study depending on amiodarone administration followed by propensity score calculation according to the 14 statistically different features found previously and six significant variables, obtaining 150 patients (75 for each group) suitable for the analysis. The length of ED stay was analyzed using box plot, with a P <0.001 in the crude analysis and P = 0.012 after propensity score matching and using survival curves for the analysis of prolonged ED stay, with a log rank <0.001 in the crude analysis and log rank 0.021 after the propensity score-matched analysis.

CONCLUSION

Amiodarone is associated with longer length of ED stay until discharge independently of the baseline characteristics of the patients.

Early Cardioversion in Atrial Fibrillation: Earlier Is Better, but Not Always and (Maybe) Not Immediately

Atrial fibrillation (AF) is the most common cardiac arrhythmia in humans. One of its important features is the tendency to become more persistent over time, even in the absence of underlying progressive heart disease. Conversion and maintenance of sinus rhythm by pharmacological or electrical methods become increasingly difficult the longer the arrhythmia persists. Electrical, mechanical, structural, and autonomic remodeling processes have been implicated in the mechanisms of AF initiation, perpetuation, and progression. Prevention or reversal of these remodeling processes can halt the progression of the disease. Cardioversion is a powerful tool and rhythm control is a widely used strategy in the management of AF. However, important questions remain unanswered regarding not only if, but also when to perform cardioversion. There are observations from past trials and clinical situations that support attempting to restore sinus rhythm, but further prospective randomized clinical trials are needed. Optimal timing of cardioversion remains somewhat uncertain, but it appears to be some time after the first few hours and before the first few months: the earlier, the better, but not always, and maybe not immediately, and it has to be tailored to the clinical situation and its many variables. This review is intended to summarize the evidence supporting early intervention for the prevention of remodeling in patients with AF.