Improvement or worsening of Heart Failure Post Cardioversion of Atrial Fibrillation: a Prospective Study

Introduction: New onset of heart failure (HF) or HF exacerbation is a known entity in patients with atrial fibrillation. We aimed to evaluate the beneficial effect of DCCV for patients with HF, the risk of developing acute HF after DCCV and the risk factors for CHF exacerbation after DCCV.

Methods: This is a single center prospective observational study in which we studied a cohort of 51 patients who underwent 56 DCCV (5 re-do). We evaluated patients who were scheduled for DCCV, predictors for HF exacerbation and immediate and 7-days outcomes after the procedure. All patients` NYHA functional class was assessed pre and post procedure and 7 days after procedure, along with 6-minute walk test (6MNWT). All patients had a serum NT-PRO_BNP value pre- and post-cardioversion.

Results: Patients` mean age was 67.5 years, 57.1% - were males. 80.4% of the patients had hypertension, 58.9% dyslipidemia, 26.8% ischemic heart disease. 25% were post CVA/TIA, and 21.4% had diabetes. The mean CHADSVASC score was 3.32, NYHA functional class was 2.16 and the average 6MNWT was 359m prior to the DCCV . baseline Pro-BNP was – 2181.6 pg/mL Restoration of sinus rhythm was achieved in 50 patients (89.3%) of the attempts.

Three patients (5.4%) developed pulmonary edema after the DCCV, and were treated successfully with medical treatment. .

Significant improvement in the functional class down to 1.9 (p<0.001), Pro-BNP to 1289 pg/mL (p<0.001) and 6MNWT(p<0.001) to 388 m was observed after the procedure in the patients who returned to sinus rhythm.

Conclusions: DCCV is a safe and effective procedure that brings symptomatic relieve to patients in heart failure. Acute HF exacerbation is a rare but serious complication of DCCV that merits special attention of the physician performing the procedure.