Efficacy and Safety of Ambulatory Electrical Cardioversion - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Nicholay Teodorovich Cardiology, Kaplan Medical Center, Rehovot, Israel Yonatan Kogan Cardiology, Kaplan Medical Center, Rehovot, Israel Michael Sraia Swissa School of Medicine, Bar Ilan University, Zefat, Israel Guy Shmuel Haber Cardiology, Kaplan Medical Center, Rehovot, Israel Gera Gandelman Cardiology, Kaplan Medical Center, Rehovot, Israel Irit Feigin Cardiology, Kaplan Medical Center, Rehovot, Israel Miri Zach Cardiology, Kaplan Medical Center, Rehovot, Israel Jacob George Cardiology, Kaplan Medical Center, Rehovot, Israel Moshe Swissa Cardiology, Kaplan Medical Center, Rehovot, Israel

Background: Electrical cardioversion is an effective tool for rapid sinus rhythm restoration in patients with symptomatic atrial fibrillation (AF). The purpose of this study was to summarize our experience in elective ambulatory electrical direct current cardioversion (DCCV) and define factors associated with procedural success.

Patients and methods: Consecutive 144 patients with AF undergoing ambulatory elective DCCV in our institution were enrolled (age 45-92, mean 71.9 years, 40.3% female). CHF was present in 18.8%; 82.6% had long standing persistent AF; 18.1% were treated with antiarrhythmic medications (85% with amiodarone); mean CHA₂DS₂VASC score was 3.3±1.7; mean creatinine level was 1.0±0.7 m/dl; mean hemoglobin level was 13.3±1.7 g/dl.

Results: Immediate sinus rhythm restoration was achieved in 139 patients (96.5%); however only 123 (85.4%) were discharged in sinus rhythm after 2 hour observation period. Restoration of sinus rhythm was not dependent on presence of hypertension, gender, antiarrhythmic medications, LVEF or creatinine level. Factors predicting immediate failure were presence of CHF (60.0% vs 17.3%, p=0.016), diabetes (80.0% vs 34.5%, p=0.038), previous stroke or TIA (40.0% vs 7.2%, p=0.009, presence of more than mild left atrial enlargement (100% vs 43.2%, p=0.008), higher CHA₂DS₂VASC score (4.8±2.1 vs 3.2±1.6, p=0.035) and lower HB level (11.8 vs 13.4 g/dL, p=0.038). All these factors were not associated with the maintenance of sinus rhythm at the discharge; with the only predictor of discharge with atrial fibrillation was use of digoxin for preprocedural rate control (14.3% vs 0.8%, p=0.012). There were no complications.

Conclusions:

Ambulatory DCCV is a safe and effective procedure for sinus rhythm restoration. Digoxin use for rate control should be discouraged before DCCV. Duration of atrial fibrillation, left atrial size and other “traditional” parameters do not predict procedural success. Antiarrhythmic drugs do not improve DCCV success. Newer parameters predicting DCCV success should be sought.