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Outcomes after nonemergent electrical cardioversion for atrial arrhythmias.

Publication ,  Journal Article
Steinberg, BA; Schulte, PJ; Hofmann, P; Ersbøll, M; Alexander, JH; Broderick-Forsgren, K; Anstrom, KJ; Granger, CB; Piccini, JP; Velazquez, EJ ...
Published in: Am J Cardiol
May 15, 2015

Electrical cardioversion (ECV) is recommended for rhythm control in patients with atrial arrhythmia; yet, ECV use and outcomes in contemporary practice are unknown. We reviewed all nonemergent ECVs for atrial arrhythmias at a tertiary care center (2010 to 2013), stratifying patients by transesophageal echocardiography (TEE) use before ECV and comparing demographics, history, vitals, and laboratory studies. Outcomes included postprocedural success and complications and repeat cardioversion, rehospitalization, and death within 30 days. Overall, 1,017 patients underwent ECV, 760 (75%) for atrial fibrillation and 240 (24%) for atrial flutter; 633 underwent TEE before ECV and 384 did not. TEE recipients were more likely to be inpatients (74% vs 44%, p <0.001), have higher mean CHADS2 scores (2.6 vs 2.4, p = 0.03), and lower mean international normalized ratios (1.2 vs 2.1, p <0.001). Overall, 89 patients (8.8%) did not achieve sinus rhythm and 14 experienced procedural complications (1.4%). Within 30 days, 80 patients (7.9%) underwent repeat ECV, 113 (11%) were rehospitalized, and 14 (1.4%) died. Although ECV success was more common in patients who underwent TEE before ECV (77% vs 68%, p = 0.01), there were no differences in 30-day death or rehospitalization rates (11.1% vs 13.0%, p = 0.37). In multivariate analyses, higher pre-ECV heart rate was associated with increased rehospitalization or death (adjusted hazard ratio 1.15/10 beats/min, 95% confidence interval 1.07 to 1.24, p <0.001), whereas TEE use was associated with lower rates (adjusted hazard ratio 0.58, 95% confidence interval 0.39 to 0.86, p = 0.007). In conclusion, failures, complications, and rehospitalization after nonemergent ECV are common and associated more with patient condition than procedural characteristics. TEE use was associated with better clinical outcomes.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 15, 2015

Volume

115

Issue

10

Start / End Page

1407 / 1414

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Rate
  • Follow-Up Studies
  • Female
  • Emergencies
  • Electric Countershock
 

Citation

APA
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Steinberg, B. A., Schulte, P. J., Hofmann, P., Ersbøll, M., Alexander, J. H., Broderick-Forsgren, K., … Shah, B. R. (2015). Outcomes after nonemergent electrical cardioversion for atrial arrhythmias. Am J Cardiol, 115(10), 1407–1414. https://doi.org/10.1016/j.amjcard.2015.02.030
Steinberg, Benjamin Adam, Phillip Joel Schulte, Paul Hofmann, Mads Ersbøll, John Hunter Alexander, Kathleen Broderick-Forsgren, Kevin Joseph Anstrom, et al. “Outcomes after nonemergent electrical cardioversion for atrial arrhythmias.Am J Cardiol 115, no. 10 (May 15, 2015): 1407–14. https://doi.org/10.1016/j.amjcard.2015.02.030.
Steinberg BA, Schulte PJ, Hofmann P, Ersbøll M, Alexander JH, Broderick-Forsgren K, et al. Outcomes after nonemergent electrical cardioversion for atrial arrhythmias. Am J Cardiol. 2015 May 15;115(10):1407–14.
Steinberg, Benjamin Adam, et al. “Outcomes after nonemergent electrical cardioversion for atrial arrhythmias.Am J Cardiol, vol. 115, no. 10, May 2015, pp. 1407–14. Pubmed, doi:10.1016/j.amjcard.2015.02.030.
Steinberg BA, Schulte PJ, Hofmann P, Ersbøll M, Alexander JH, Broderick-Forsgren K, Anstrom KJ, Granger CB, Piccini JP, Velazquez EJ, Shah BR. Outcomes after nonemergent electrical cardioversion for atrial arrhythmias. Am J Cardiol. 2015 May 15;115(10):1407–1414.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 15, 2015

Volume

115

Issue

10

Start / End Page

1407 / 1414

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Rate
  • Follow-Up Studies
  • Female
  • Emergencies
  • Electric Countershock