Original research

Short-term and long-term success of electrical cardioversion in atrial fibrillation in managed care system

Suman S Kuppahally¹ , Elyse Foster² , Stanford Shoor³ and Anthony E Steimle⁴

¹  Division of Cardiology, University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA

²  Division of Cardiology, Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, M314A San Francisco, CA, 94143-0214, USA

³  Department of Medicine, Kaiser Permanente Santa Clara Medical Center, 710 Lawrence Expressway, Santa Clara, CA, 95051, USA.

⁴  Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, 710 Lawrence Expressway, Santa Clara, CA, 95051, USA

author email corresponding author email

International Archives of Medicine 2009, 2:39doi:10.1186/1755-7682-2-39

Published:	12 December 2009

Abstract

Background

Initial success of electrical cardioversion (ECV) of atrial fibrillation (AF) has been reported in several studies as 50%-90%, of which only 50% patients remain in sinus rhythm (SR) at the end of one year. We conducted this study to see if outcomes of other trials are applicable in managed care setting.

Methods

We conducted a retrospective study in 370 consecutive patients who underwent ECV for AF. They were reviewed for initial outcome of ECV and recurrence of AF after a successful ECV, with and without prophylactic antiarrhythmic drugs.

Results

Initial success of ECV for AF was 65.7%. At one year, 47% remained in SR. AF for ≤ 3 months (p = 0.006) and pretreatment with antiarrhythmic drugs (p = 0.032) resulted in improved success. Predictors of recurrence were patients ≤ 65 years (p = 0.019), paroxysmal atrial fibrillation (PAF) (p = 0.0094) and alcohol consumption (p = 0.0074).

Conclusion

Shorter duration of AF, prophylactic antiarrhythmic drugs and serial ECVs improve outcome of ECV in AF. For younger patients with PAF and alcohol consumption, due to higher recurrence of AF, rate control or ablative therapy may be the preferred strategy.