Outcome of direct current cardioversion for atrial arrhythmias in adults with congenital heart disease
Abstract
Objectives We sought to evaluate safety, efficacy, and outcome of direct current cardioversion (DCCV) for atrial arrhythmias in adults with congenital heart disease (CHD).Background Atrial arrhythmias are increasingly noted in adults with CHD. The outcome of DCCV for atrial arrhythmias in this population is unknown.Methods Our study was a retrospective review of patients 18 years or older with CHD who underwent DCCV between June 2000 and July 2003. This constituted the CHD group. Patient characteristics reviewed included the specific cardiac diagnosis and arrhythmia history. A subset of patients had transesophageal echocardiography (TEE) before DCCV; this subset was reviewed to evaluate spontaneous echocardiographic contrast. The outcome data evaluated included success of DCCV, complications, recurrence of arrhythmia, antiarrhythmic medication use, electrophysiology or pacemaker procedure in follow-up, and all-cause mortality. The recurrence rate of the arrhythmia was compared to a control group consisting of an age, gender, and rhythm matched group of patients who have no CHD and who underwent DCCV for atrial arrhythmias.Results Sixty-three patients in the CHD group underwent 80 DCCVs, 59 of which were TEE-guided. Atrial flutter was more common in the CHD group (37 of 80 DCCV, 46%) than in the control group (13 of 56, 23%) (p<0.001). DCCV was successful in 75 (94%). Mean follow-up was 387 days. No thromboembolic events were noted. All-cause mortality on follow-up was 11%. There was no death related to DCCV. Twenty-five patients in the CHD group (40%) remained in sinus rhythm throughout follow-up. This was similar to that observed in the control group (30/56, 54%, p=0.13). Recurrent arrhythmia in the CHD group was predicted by the presence of atrial fibrillation (p=0.009) and less so spontaneous echo contrast in the left atrium (p=0.05).Conclusions DCCV with appropriate anticoagulation is safe and effective for patients with CHD, even in the presence of an intracardiac shunt and spontaneous contrast on TEE. However, the recurrence rate is substantial. Spontaneous echo contrast in the left atrium along with atrial fibrillation predicts arrhythmia recurrence following DCCV in patients with CHD.
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They are associated with heart failure, syncope, thromboembolic events, and sudden death.
“They are associated with heart failure, syncope, thromboembolic events, and sudden death.[963][964][965][966][967]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [964]
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- Authors
- Ammash, N. M., Phillips, S. D., Hodge, D. O., Connolly, H. M., Grogan, M. A., Friedman, P. A., Warnes, C. A., & Asirvatham, S. J.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Ammash, Naser M.
- ORCID
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 154
- Issue
- 3
- Pages
- 270-274
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2000468338
- Cited by
- 55
- References
- 27
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 3 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 9 · 2014: 7 · 2013: 5
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- electrical cardioversion, atrial arrhythmias, congenital heart disease, atrial flutter, atrial fibrillation, spontaneous echo contrast, transesophageal echocardiography, arrhythmia recurrence, intracardiac shunt, anticoagulation, all-cause mortality, adult congenital heart disease, sinus rhythm maintenance, antiarrhythmic drugs, electrophysiology
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Arrhythmias, Cardiac, Electric Countershock, Female, Heart Atria, Heart Diseases, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult
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