Pharmacological Cardioversion After Pre-Treatment with Antiarrythmic Drugs Prior to Electrical Cardioversion in Persistent Atrial Fibrillation: Impact on Maintenance of Sinus Rhythm

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Apr 3

PMID 33802253

Citations 3

Authors

Amine El Amrani

Xavier Vinolas

Miguel Angel Arias

Victor Bazan

Pilar Valdovinos

Josep M Alegret

Affiliations

Soon will be listed here.

Abstract

Background: Antiarrhythmic drugs (AADs) are frequently initiated in patients with persistent atrial fibrillation (AF) prior to electrical cardioversion (ECV), achieving pharmacological cardioversion (PCV) in some cases. Little is known about the mode of cardioversion and the effect of the type of AAD used in the maintenance of sinus rhythm (SR).

Methods: From three national surveys of patients with persistent AF referred for ECV, we selected those who were pre-treated with AADs (amiodarone or group Ic AADs). We analyzed the effect of the type of cardioversion (pharmacological vs. electrical) and the AAD used in the maintenance of SR at three months.

Results: Among the 665 patients selected, 151 had a successful PCV prior to the planned ECV. In the remaining 514 patients, 460 had a successful ECV. A successful PCV was related to a higher rate of SR maintenance than a successful ECV (77.9% vs. 57.5%; < 0.0001). After a successful PCV, the maintenance of SR was identical in those patients treated with amiodarone and those treated with group Ic AADs (77.4% vs. 77.5%; = 0.99), whereas after a successful ECV, amiodarone was clearly superior to group Ic AADs (61.3% vs. 43.0%; = 0.001). Considering patients with successful PCV and ECV together, PCV was an independent factor related to the maintenance of SR.

Conclusions: In patients with persistent AF, successful PCV selects a subgroup with a high probability of maintenance of SR. With regard to drugs, amiodarone was superior to group Ic AADs in patients with ECV, whereas in PCV, no differences were observed.

Citing Articles

Evaluation of Changes in Cardiac Troponin I Levels After Direct Current Cardioversion in Patients With Atrial Fibrillation.

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Impact of Body Mass Index in the Cardioverter Efficacy of Amiodarone in Persistent Atrial Fibrillation.

Ligero C, Riera P, El-Amrani A, Bazan V, Guerra J, Herraez S Pharmaceuticals (Basel). 2024; 17(6).

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Outcome Analysis in Elective Electrical Cardioversion of Atrial Fibrillation Patients: Development and Validation of a Machine Learning Prognostic Model.

Nunez-Garcia J, Sanchez-Puente A, Sampedro-Gomez J, Vicente-Palacios V, Jimenez-Navarro M, Oterino-Manzanas A J Clin Med. 2022; 11(9).

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