Electrical cardioversion for atrial fibrillation: outcomes in 'real-life' clinical practice

被引:37
作者
Berry, C
Stewart, S
Payne, EM
McArthur, JD
McMurray, JJV
机构
[1] Western Infirm & Associated Hosp, Dept Cardiol, Glasgow G11 6NT, Lanark, Scotland
[2] Univ Glasgow, Dept Publ Hlth, Glasgow G12 8QQ, Lanark, Scotland
基金
英国医学研究理事会;
关键词
atrial fibrillation; cardioversion; quality of life;
D O I
10.1016/S0167-5273(01)00522-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: There is currently considerable debate with regard to the optimal management of atrial fibrillation/flutter (AT), including the lon.-term. success of electrical cardioversion and the duration of anti-coagulation thereafter. The aim of this study was to investigate the current management and outcomes of electrical cardioversion in unselected patients in ordinary clinical practice. Methods: A prospective, observational study of 111 consecutive patients with AF who had been referred for electrical cardioversion was undertaken in a large teaching hospital. After cardioversion, patients were followed-up for 12 months or until death if this occurred earlier. Results: Sinus rhythm was restored immediately in 96 of 111 (86%) patients. Only 54 of 88 (61%) patients in sinus rhythm at discharge remained in this rhythm at 1 month. Of these 54, a further 21 (39%) had relapsed into AT by 12 months. Independent predictors of sinus rhythm at discharge were younger age (for a difference of 5 years, odds ratio=1.54; 95% confidence interval 1.04 to 1.16; P=0.002) and absence of hypertension (1.73, 1.22-1.91; P=0.015). The presence of sinus rhythm at discharge (6.4, 1.6-25.3; P=0.007) was an independent predictor of sinus rhythm at 1 month, whereas older age was a negative predictor (0.96, 0.92-1.0; P=0.05). Health-related quality of life improved at 1 and 12 months in those patients who remained in sinus rhythm compared to those who remained in AF. Conclusions: Though electrical cardioversion for AF has a high initial success rate only a minority of patients remained in sinus rhythm 1 year. The common practice of discontinuing anticoagulant treatment in patients in sinus rhythm at 1 month may be unsafe. Long-term maintenance of sinus rhythm is, however, associated with better health-related quality of life. (C) 2001 Published by Elsevier Science Ireland Ltd.
引用
收藏
页码:29 / 35
页数:7
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