Cardiovascular events of electrical cardioversion under optimal anticoagulation in atrial fibrillation: The multicenter analysis

Dong Geum Shin, Iksung Cho, Bríain Hartaigh, Hee Sun Mun, Hye Young Lee, Eui Seock Hwang, Jin Kyu Park, Jae Sun Uhm, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale 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.

Original languageEnglish
Pages (from-to)1552-1558
Number of pages7
JournalYonsei medical journal
Volume56
Issue number6
DOIs
Publication statusPublished - 2015 Nov

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Electric Countershock
Atrial Fibrillation
Stroke
Transient Ischemic Attack
Hemorrhage
International Normalized Ratio
Amiodarone
Anti-Arrhythmia Agents
Calcium Channel Blockers
Bradycardia
Tertiary Care Centers
Hospitalization
Heart Failure
Heart Rate
History

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Shin, Dong Geum ; Cho, Iksung ; Hartaigh, Bríain ; Mun, Hee Sun ; Lee, Hye Young ; Hwang, Eui Seock ; Park, Jin Kyu ; Uhm, Jae Sun ; Pak, Hui Nam ; Lee, Moon Hyoung ; Joung, Boyoung. / Cardiovascular events of electrical cardioversion under optimal anticoagulation in atrial fibrillation : The multicenter analysis. In: Yonsei medical journal. 2015 ; Vol. 56, No. 6. pp. 1552-1558.
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abstract = "Purpose: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale 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.",
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Cardiovascular events of electrical cardioversion under optimal anticoagulation in atrial fibrillation : The multicenter analysis. / Shin, Dong Geum; Cho, Iksung; Hartaigh, Bríain; Mun, Hee Sun; Lee, Hye Young; Hwang, Eui Seock; Park, Jin Kyu; Uhm, Jae Sun; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung.

In: Yonsei medical journal, Vol. 56, No. 6, 11.2015, p. 1552-1558.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiovascular events of electrical cardioversion under optimal anticoagulation in atrial fibrillation

T2 - The multicenter analysis

AU - Shin, Dong Geum

AU - Cho, Iksung

AU - Hartaigh, Bríain

AU - Mun, Hee Sun

AU - Lee, Hye Young

AU - Hwang, Eui Seock

AU - Park, Jin Kyu

AU - Uhm, Jae Sun

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

PY - 2015/11

Y1 - 2015/11

N2 - Purpose: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale 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.

AB - Purpose: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale 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.

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