Risk Factors of Complications in Patients With Persistent or Long-Standing Persistent Atrial Fibrillation/Atrial Flutter Who Underwent Electrical Cardioversion: A Multicenter Cardioversion Registry
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Identifying the risks related to the complications of electrical cardioversion (ECV) can alert the determinaton of rhythm control in patients with atrial fibrillation (AF). METHODS: We retrospectively reviewed 1,058 patients who underwent ECV for persistent or long-standing persistent AF/atrial flutter (AFL) from multiple centers. Patients were classified into the no-complication (1,023 patients) and complication (35 patients) groups based on the following major complications: stroke and/or systemic embolism (SSE), myocardial infarction, major bleeding, implantation of cardiac implantable electronic devices, ventricular tachycardia/fibrillation, and death at 1 year follow-up after ECV. RESULTS: Compared with the no-complication group, the complication group exhibited a higher proportion of female patients (37% vs. 22%), as well as a higher proportion of patients with older age (67 ± 11 vs. 61 ± 10 years), diabetes mellitus (DM) (49% vs. 24%), heart failure (HF) (49% vs. 30%), SSE (23% vs. 9%), high CHA₂DS₂-VASc (CV) score (3.6 ± 1.8 vs. 2.2 ± 1.4), low left ventricular ejection fraction (LVEF) (50 ± 16% vs. 58 ± 21%), and high left atrial volume index (LAVI) (51 ± 26 vs. 40 ± 20 mL/m²). Class I and III antiarrhythmics were less prescribed in the complication group than in the no-complication group (57% vs. 76%). Univariate analysis for complications revealed age (≥ 65 years), female sex, DM, HF, SSE, LVEF (< 50%), LAVI (≥ 40 mL/m²), CV score (≥ 3), bradycardia on Holter (< 60/min), and no antiarrhythmics as risk factors. Among these, multivariate analysis revealed clinical significance of female sex and SSE. CONCLUSION: Female sex and a history of SSE were the most important risk factors of complications in patients with persistent or long-standing persistent AF/AFL who underwent ECV.
Authors: Ki-Hun Kim, Junbeom Park, Donghwan Ku, Jino Park, Seunghwan Kim, Dong-Kie Kim, Doo-Il Kim, Sun Gyu Choi, Pil-Sung Yang, Ju Youn Kim, Jaemin Shim, Jinhee Ahn, Sung Ho Lee, Sung Il Im, Hong Euy Lim
Institutions: Inje University, Inje University Haeundae Paik Hospital, Ewha Womans University, Ewha Womans University Medical Center, Ewha Womans University Seoul Hospital, CHA University Bundang Medical Center, CHA University, Samsung Medical Center, Sungkyunkwan University, Korea University Anam Hospital, Pusan National University Hospital, Pusan National University, Kangbuk Samsung Hospital, Kosin University Gospel Hospital, Kosin University, Chung-Ang University Gwangmyeong Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $690
Funder: Heart Rhythm Society
OpenAlex ID: W4417104707