How to Optimize Cardioversion of Atrial Fibrillation.
Kari Eino Juhani AiraksinenPublished in: Journal of clinical medicine (2022)
Cardioversion (CV) is an essential component of rhythm control strategy in the treatment of atrial fibrillation (AF). Timing of CV is an important manageable factor in optimizing the safety and efficacy of CV. Based on observational studies, the success rate of CV seems to be best (≈95%) at 12-48 h after the onset of arrhythmic symptoms compared with a lower success rate of ≈85% in later elective CV. Early AF recurrences are also less common after acute CV compared with later elective CV. CV causes a temporary increase in the risk of thromboembolic complications. Effective anticoagulation reduces this risk, especially during the first 2 weeks after successful CV. However, even during therapeutic anticoagulation, each elective CV increases the risk of stroke 4-fold (0.4% vs. 0.1%) during the first month after the procedure, compared with acute (<48 h) CV or avoiding CV. Spontaneous CVs are common during the early hours of AF. The short wait-and-see approach, up to 24-48 h, is a reasonable option for otherwise healthy but mildly symptomatic patients who are using therapeutic anticoagulation, since they are most likely to have spontaneous rhythm conversion and have no need for active CV. The probability of early treatment failure and antiarrhythmic treatment options should be evaluated before proceeding to CV to avoid the risks of futile CVs.
Keyphrases
- atrial fibrillation
- catheter ablation
- left atrial
- oral anticoagulants
- left atrial appendage
- patients undergoing
- percutaneous coronary intervention
- intensive care unit
- end stage renal disease
- chronic kidney disease
- newly diagnosed
- blood brain barrier
- physical activity
- risk assessment
- coronary artery disease
- ejection fraction
- acute coronary syndrome
- subarachnoid hemorrhage
- hepatitis b virus
- depressive symptoms
- acute respiratory distress syndrome
- human health
- mechanical ventilation
- drug induced
- mitral valve
- brain injury
- peritoneal dialysis
- replacement therapy