Optimal timing for cardioversion in patients with atrial fibrillation
Optimal timing for cardioversion in patients with atrial fibrillation
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DOI：
10.1002/clc.22986
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发表时间：
2018-07-01
影响因子：
2.7
通讯作者：
Airaksinen, K. E.
中科院分区：
文献类型：
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作者：
Hellman, Tapio;Kiviniemi, Tuomas;Airaksinen, K. E.
背景：电复律（CV）在房颤（AF）的节律管理中是必不可少的。然而，CV的最佳时机仍然未知。假设：房颤患者CV时间与不良事件风险相关。方法：我们在一项多中心、多队列研究中分析了AF发作持续时间对电CV安全性和有效性的影响，该研究对2530例口服抗凝患者的4356例CV进行了研究。复合不良结局包括不成功的CV、急性心律失常并发症、血栓栓塞事件、死亡率和随访30天内房颤复发。结果：根据AF指数发作持续时间（30d）对研究组进行分层，分别包括1767、516、632和1441个cv。cv不成功率为8.5% (30d) （P < 0.01）。在30天的随访中，血栓栓塞事件（0.1%）、死亡率（0.1%）和无骤停bbb50秒（0.7%）的发生率不高，在各研究组中具有可比性。术后30d内复发率分别为29.8% (30d) （P < 0.01）。在多因素分析中，1669例（38.4%）cv发生了综合不良结局，AF发作指数bbb48小时是综合终点的独立预测因子（OR: 1.49, 95% CI: 1.28-1.74, P < 0.01）。结论：房颤的最佳CV时间呈j型曲线，在房颤发病24至48小时后进行CV治疗的患者不良后果最少。在心律控制策略的患者中，延迟CV bb0 48小时与不良后果风险增加相关。
Background: Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown.Hypothesis: Timing of CV in AF is associated with risk of adverse events.Methods: We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30-day follow-up.Results: Study groups were stratified according to duration of index AF episode ( 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (30d), respectively (P < 0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (30d), respectively (P < 0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P < 0.01) in multivariate analysis.Conclusions: Optimal timing of CV for AF showed a J-shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm-control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.