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Cardioversion and subsequent quality of life and natural history of atrial fibrillation

Year: 2016
Type: article
Abstract: Cardioversion is a class I procedure for patients with symptomatic atrial fibrillation (AF) pursuing rhythm control. There are few contemporary reports on quality of life and outcomes after cardioversion. METHODS: Using the nationwide prospective ORBIT-AF registry, cardioversion patients were propensity matched 3:1 to noncardioverted patients and Cox proportional hazards modeling evaluated hospitalization at 1 year in those with and without cardioversion. Cardiovascular outcomes, AF progression, and quality of life were evaluated for the matched cohorts with and without cardioversion. RESULTS: Among 9,642 patients, 817 patients (8%) underwent 906 cardioversions during a median follow-up of 12 (interquartile range 6-18) months. Among matched cardioverted and noncardioverted patients, 1-year cardiovascular hospitalization rates were 43% vs 21% (adjusted hazard ratio 2.2, 95% CI 1.8-2.8, P<.001), and sinus rhythm at both first and second follow-ups was 36% vs 27% (P=.042), respectively. Findings were similar among first-time cardioversion patients. Matched cardioversion patients did not exhibit greater symptom improvement (34% vs 42%) or less symptomatic progression (15% vs 4%) by European Heart Rhythm Association scores. Cardioversion was associated with AF progression with an odds ratio of 1.6 (95% CI 1.2-2.2, P=.001) after cardioversion and 2.7 (P<.001) after first cardioversion vs matched noncardioversion patients. After cardioversion, only 18% of patients not previously on an antiarrhythmic started one, less than 5% underwent ablation, and 22% stopped their antiarrhythmic. CONCLUSIONS: Cardioversion was not associated with improved AF-related quality of life or less progression. Many patients who undergo cardioversion do not receive adjunctive rhythm control therapies. These findings may help to better inform therapeutic decision making.
DOI: 10.1016/j.ahj.2016.10.018
Authors: Sean D. Pokorney, Sunghee Kim, Laine Thomas, Gregg C. Fonarow, Peter R. Kowey, Bernard J. Gersh, Kenneth W. Mahaffey, Eric D. Peterson, Jonathan P. Piccini
Institutions: Duke University, Duke Medical Center, Duke Clinical Research Institute, University of California, Los Angeles, Lankenau Institute for Medical Research, Mayo Clinic, Stanford Medicine, Stanford University
Language: English
Field: Medicine
Open Access status: hybrid
Estimated APC paid: $4,070
Funders: American Heart Association, Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, Boston Scientific Corporation, Bayer HealthCare, Genentech, Stanford Bio-X, Janssen Pharmaceuticals
OpenAlex ID: W2546051287
FWCI: 0.826
Cites: 19
Cited by: 27
Related to: 10