A comparison of early versus delayed elective electrical cardioversion for recurrent episodes of persistent atrial fibrillation: A multi-center study.

Abstract

BACKGROUND\nDue to barriers to accessing timely elective electrical cardioversion (CV) for persistent AF (PeAF), we adopted a policy of instructing patients to present directly to the Emergency Department (ED) for CV.\n\n\nOBJECTIVE\nWe compare a strategy of Emergency CV (ED-CV) versus Elective CV (EL-CV) for treatment of symptomatic PeAF.\n\n\nMETHODS\nBetween 2014 and 7, we evaluated 150 patients undergoing CV for PeAF. ED-CV patients were provided an AF action plan for recurrent symptoms and advised to present to ED within 36\u202fh. EL-CV patients followed standard care, including cardiologist referral and placement on an elective hospital waiting list. Follow-up was 12\u202fmonths.\n\n\nRESULTS\nWe included 75 consecutive ED-CV patients and 75 consecutive EL-CV patients. ED-CV patients had a significantly shorter median AF duration prior to CV (1\u202fday vs 3\u202fmonths; p\u202f<\u202f0.01) and less overall AF-related symptoms at 12\u202fmonths (modified EHRA symptom score\u202f≥\u202f2a in 44% vs 72%; p\u202f=\u202f0.005). Time to next AF recurrence was longer in the ED-CV group (295\u202f±\u202f15 vs 245\u202f±\u202f15\u202fdays; logrank p\u202f=\u202f0.001), as was time to AF ablation referral (314\u202f±\u202f13 vs 276\u202f±\u202f15\u202fdays; logrank p\u202f=\u202f0.01). Baseline LA area was similar (ED-CV 27\u202f±\u202f4\u202fcm2 vs EL-CV 28\u202f±\u202f11\u202fcm2; p\u202f=\u202f0.67), however EL-CV had larger atria at follow-up (31\u202f±\u202f8 vs 26\u202f±\u202f6\u202fcm2; p\u202f=\u202f0.01). There were no complications in either group.\n\n\nCONCLUSION\nED-CV is an acceptable strategy for symptomatic PeAF. In addition to reduced time spent in AF and improved symptom scores, this strategy may also slow progression of atrial substrate & delay onset of next AF episode.