Outcomes of patients undergoing elective DC cardioversion for atrial fibrillation: A district general hospital experience.

Abstract

Background: DC cardioversion (DCCV), when performed early, effectively restores sinus rhythm in patients with atrial fibrillation (AF). This audit aimed to evaluate the outcomes of patients undergoing DCCV at our institution and assess the factors predicting restoration of sinus rhythm.

Methods: This retrospective audit included patients who underwent elective DCCV in 2021 at our hospital. We excluded patients where data was incomplete. Data was collected from the electronic case records of the patients.

Results: Two hundred forty-three patients (mean age 67.5±11.7 years, 67.1% male) were included in the analysis. The median delay from DCCV decision was 265 (108-826) days. Patients who were initially managed with rate control (158 (65%) patients) had longer DCCV wait times compared to those where DCCV was considered as the first line treatment (308 vs. 114 days, p<0.001). DCCV was immediately successful in 232 (93.1%) patients, with 226 (91.5%) maintaining sinus rhythm at discharge, 120 (48.6%) at 6 months and 98 (39.7%) at one year. Fewer shocks predicted sinus rhythm maintenance at discharge, 6 months, and one year (p<0.001). Amiodarone continued post-DCCV also predicted maintenance of sinus rhythm at one year (p=0.01). No significant differences were found in demographics, risk factors, DCCV delay, or LA size between those who maintained sinus rhythm and those who reverted to AF.

Conclusion: At our institution, most patients experienced significant delays before elective cardioversion. Decision to perform DCCV should be taken early and not after an initial trial of rate control. In our patients, amiodarone helped maintain sinus rhythm after successful DCCV.