Arrhythmic complications after electrical cardioversion of acute atrial fibrillation: the FinCV study
Open accessAbstract
AIMS: To determine the incidence and risk factors of arrhythmic complications after electrical cardioversion of acute atrial fibrillation (AF). METHODS AND RESULTS: Our retrospective multicentre study collected data from 7660 cardioversions of acute (<48 h) AF in 3143 consecutive patients. Immediate arrhythmic complications were evaluated after 6906 (90.2%) electrical cardioversions performed in 2868 patients. We also assessed the predictors of arrhythmic complications and whether post-cardioversion bradycardia or asystole led to later a permanent pacemaker implantation. Altogether, 63 (0.9%) electrical cardioversions resulted in bradyarrhythmia in 54 patients. Asystole (>5 s) occurred immediately after 51 cardioversions leading to a short resuscitation in seven cases and two patients needed extrinsic pacing after the cardioversion. In nine cases, asystole was followed by bradycardia. Bradycardic ventricular rate (<40 b.p.m.) alone was seen after 12 procedures. No ventricular arrhythmias needing intervention were detected. Old age [odds ratio (OR) 1.1; 95% confidence interval (CI) 1.05-1.10, P < 0.0001], female sex (OR 2.5; 95% CI 1.4-4.8, P = 0.004), and unsuccessful cardioversion (OR 2.2; 95% CI 1.1-4.6, P = 0.03) were the independent predictors of bradycardic complications. Slow ventricular rate, use of digoxin, beta blocker, or antiarrhythmic medication did not increase the risk of bradycardic complications. Pacemaker was implanted in 24 (44.4%) patients after a median delay of 66 days. CONCLUSION: Bradycardic complications are rare and usually benign after cardioversion of acute AF. They seem to reflect sinus node dysfunction and often result in later implantation of a permanent pacemaker.
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New evidence indicates that initiating precardioversion anticoagulation in patients with AF episodes of < 24 hours or even < 12 hours would provide even better safety.
“However, new evidence has emerged that initiating precardioversion anticoagulation in patients with AF episodes of < 24 hours or even < 12 hours would provide even better safety.642,647,[1026][1027][1028]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [1026]
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Acute direct current cardioversion: how 'dangerous' is it?
Rosenqvist, M. A. (2013) · EP Europace · doi:10.1093/europace/eut221
A Five Year Audit of DC Cardioversion for Patients with Atrial Fibrillation in East London
Draeger, T. B., Wright, S., Meenakshisundaram, R., & Kadr, H. (2017) · Journal of Universal Surgery · doi:10.21767/2254-6758.100058
THE UNRESOLVED ISSUES AND MODERN VIEW ON ATRIAL FIBRILLATION PATIENTS MANAGEMENT
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Einfach und praktisch: Elektrische Kardioversion
Ventzke, M.-M., Weiner, T., Lauer, S., & Segitz, O. (2021) · Notfall + Rettungsmedizin · doi:10.1007/s10049-021-00843-7
Cardiovascular Toxicities of Proteasome Inhibitors
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- Authors
- Grönberg, T., Nuotio, I., Nikkinen, M., Ylitalo, A., Vasankari, T., Hartikainen, J. E. K., & Airaksinen, K. E. J.
- Affiliations
- Turku University Hospital (FI)
- Kuopio University Hospital (FI)
- Satakunta Central Hospital (FI)
- Venue
- EP Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-05-17
- Volume
- 15
- Issue
- 10
- Pages
- 1432-1435
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2322905370
- Cited by
- 76
- References
- 24
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 9 · 2023: 7 · 2022: 4 · 2021: 8 · 2020: 8 · 2019: 3 · 2018: 4 · 2017: 3 · 2016: 9 · 2015: 4 · 2014: 2 · 2013: 2
- FWCI
- 3.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Foundation for Cardiovascular Research
- Kuopion Yliopistollinen Sairaala
- Sydäntutkimussäätiö
- Turun Yliopistollinen Keskussairaala
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- atrial fibrillation, electrical cardioversion, arrhythmic complications, bradycardia, asystole, permanent pacemaker implantation, sick sinus syndrome, risk factors
- MeSH terms
- Acute Disease, Age Factors, Aged, Atrial Fibrillation, Bradycardia, Cardiac Pacing, Artificial, Electric Countershock, Female, Finland, Heart Arrest, Heart Rate, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Sex Factors, Sinoatrial Node, Time Factors, Incidence, Multivariate Analysis, Chi-Square Distribution, Odds Ratio, Treatment Outcome
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