Cardiovascular Events of Electrical Cardioversion Under Optimal Anticoagulation in Atrial Fibrillation: The Multicenter Analysis

Purpose: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, large-scale study about the acute cardiovascular events following electrical cardioversion of AF is lacking. This study was performed to evaluate the incidence, risk factors, and clinical consequences of acute cardiovascular events following electrical cardioversion of AF. Materials and Methods: The study enrolled 1100 AF patients (mean age 60 11 years) who received cardioversion at four tertiary hospitals. Hospitalizations for stroke/transient ischemic attack, major bleedings, and arrhythmic events during 30 days post electric cardioversion were assessed. Results: The mean duration of anticoagulation before cardioversion was 95.8 +/- 51.6 days. The mean International Normalized Ratio at the time of cardioversion was 2.4 +/- 0.9. The antiarrhythmic drugs at the time of cardioversion were class I(45%), amiodarone (40%), beta-blocker (53%), calcium-channel blocker (21%), and other medication (11%). The success rate of terminating AF via cardioversion was 87% (n=947). Following cardioversion, 5 strokes and 5 major bleedings occurred. The history of stroke/transient ischemic attack (OR 6.23, 95% CI 1.69-22.90) and heart failure (OR 6.40, 95% CI 1.77-23.14) were among predictors of thromboembolic or bleeding events. Eight patients were hospitalized for bradyarrhythmia. These patients were more likely to have had a lower heart rate prior to the procedure (p=0.045). Consequently, 3 of these patients were implanted with a permanent pacemaker. Conclusion: Cardioversion appears as a safe procedure with a reasonably acceptable cardiovascular event rate. However, to prevent the cardiovascular events, several risk factors should be considered before cardioversion.This study was supported in part by research grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (NRF-2010-0021993, NRF-2012 R1A2A2A02045367), and a grant of the Korean Healthcare technology R&D project funded by Ministry of Health & Welfare (HI12C1552)