Optimal timing for cardioversion in patients with atrial fibrillation

Background: Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown. Hypothesis: Timing of CV in AF is associated with risk of adverse events. Methods: We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30-day follow-up. Results: Study groups were stratified according to duration of index AF episode ( 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (30d), respectively (P 5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (30d), respectively (P 48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P 48 hours is associated with increased risk for adverse outcomes.Peer reviewe