The prognostic impact of successful cardioversion of atrial fibrillation in patients with organic heart disease

Abstract

The aim of the study was to evaluate the prognostic impact of successful cardioversion (CV) compared to failed CV in patients with atrial fibrillation (AF) and organic heart disease. A total of 471 consecutive patients with organic heart disease from the prospective single center anticoagulation registry ANTIK who underwent CV of AF or atrial flutter were analyzed. 417 patients (89%) could be successfully cardioverted. In 54 patients (11%) CV failed, these patients remained in AF. After 5 years there were 92 (24%) deaths among patients with restored sinus rhythm at index admission and 20 (38%) deaths among those who remained in AF after CV (unadjusted OR 1.9, 95% CI 1.1-3.6). After adjustment for age, gender and ejection fraction, successful CV was not associated with a beneficial effect on mortality (OR 0.72, 95% CI 0.43-1.21). Thus, successful CV is not an independent predictor of mortality on multivariate analysis. However, it remains a marker for a better prognosis in patients with organic heart disease as these patients have a lower unadjusted longterm mortality.

The Incidence and Prognosis of Renal Dysfunction following Cardioversion of Atrial Fibrillation

“…While prospective studies have not demonstrated differences in mortality between rate control and rhythm control strategies, sinus rhythm may provide significant symptomatic improvement, and many patients with persistent atrial fibrillation undergo electrical or pharmacological cardioversion [2,3,4,5]. Direct current cardioversion (DCCV) is associated with known risks including thromboembolism, complications associated with sedation such as aspiration or respiratory arrest, sinus bradycardia, hypotension and rarely pulmonary edema [6,7,8,9]. …”

Risk of Kidney Injury following Cardioversion for Atrial Fibrillation

“…DCCVs are associated with risks including thromboembolism, complications associated with sedation/anesthesia (e.g. aspiration or respiratory arrest), sinus bradycardia, hypotension and, rarely, pulmonary edema [10,11,12,13]. There are also reports of acute rabdomyolysis and acute renal failure after cardioversion in seriously ill patients including those with cardiopulmonary arrest [14,15,16].…”