Long-term outcome of electrical cardioversion in patients with chronic atrial flutter
Open accessAbstract
OBJECTIVE: To determine the long-term outcome of serial electrical cardioversion therapy in patients with chronic atrial flutter. DESIGN: Prospective study, case series. SETTING: University hospital. PATIENTS: 50 consecutive patients with chronic (> 24 hours) atrial flutter without a previous relapse on antiarrhythmic drugs. INTERVENTIONS: Elective electrical cardioversion therapy, if necessary repeated, to obtain and keep patients in sinus rhythm. If the first cardioversion resulted in sinus rhythm, patients were not given antiarrhythmic drugs. Relapses were managed by repeated cardioversions then anti-arrhythmic drugs were used serially in a set sequence. MAIN OUTCOME MEASURE: Maintenance of sinus rhythm. RESULTS: Mean (SD) follow up was 3.5 (1.7) years. The first cardioversion was successful in 48 patients (96%). After a single shock and without antiarrhythmic drugs being used, 42% of the patients maintained sinus rhythm in the long-term. Only left atrial size was inversely related to the efficacy of one shock (P = 0.025). With serial cardioversion 90% of the patients were kept in sinus rhythm for 5 years. Univariate analysis showed that a long duration of arrhythmia and impaired cardiac function were both related to poor outcome. During follow up 3 patients died of progression of heart failure and another 5 died suddenly. None of these 5 patients was on antiarrhythmic drugs. CONCLUSIONS: Electrical cardioversion was an effective and safe method of converting chronic atrial flutter to sinus rhythm. To maintain sinus rhythm, more than half of the patients required multiple shocks and prophylactic antiarrhythmic drugs. Sudden death was relatively frequent in the study population; the limited data available from this study suggest that such deaths were caused by the underlying disease and not drug related proarrhythmia.
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The poor outcomes of rhythm-control strategies seen in atrial fibrillation may also apply to atrial flutter when antiarrhythmic drugs are used.
“but with the use of antiarrhythmic drugs, the poor results of rhythm control strategies in AF may also apply to AFL. 152,153”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [152]
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- Authors
- Crijns, H. J., Van Gelder, I. C., Tieleman, R. G., Brügemann, J., De Kam, P. J., Gosselink, A. T., Bink-Boelkens, M. T., & Lie, K. I.
- Affiliations
- University Medical Center Groningen (NL)
- Venue
- Heart
- Publisher
- BMJ
- Published
- 1997-01
- Volume
- 77
- Issue
- 1
- Pages
- 56-61
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- PMC
- PMC484636
- OpenAlex
- W2102490704
- Cited by
- 46
- References
- 26
- Citations by year
- 2025: 4 · 2022: 1 · 2021: 1 · 2020: 2 · 2018: 2 · 2016: 3 · 2015: 1 · 2012: 2
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- UvA-DARE (University of Amsterdam) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial flutter, electrical cardioversion, sinus rhythm maintenance, antiarrhythmic drugs, long-term outcomes, left atrial size, sudden death, heart failure, drug-induced arrhythmia
- MeSH terms
- Atrial Flutter, Chronic Disease, Electric Countershock, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Regression Analysis, Treatment Outcome
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