1
|
Taha HI, Nazir A, Ibrahim AA, Elgendy MS, Shubietah A, Mansour HR, Sary S, Maged M, Turkmani M, Abuelazm M. Active Compression During External Cardioversion of Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials. Ann Noninvasive Electrocardiol 2025; 30:e70074. [PMID: 40167272 PMCID: PMC11959626 DOI: 10.1111/anec.70074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 03/04/2025] [Accepted: 03/22/2025] [Indexed: 04/02/2025] Open
Abstract
OBJECTIVES Direct current cardioversion (DCCV) is commonly used for atrial fibrillation, but there is uncertainty about whether active chest compression improves its effectiveness. This meta-analysis evaluates the impact of active compression on cardioversion outcomes. METHODS A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. Statistical analysis was performed using R software (version 4.3.1), applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). PROSPERO ID CRD42024595499. RESULTS Four RCTs with 737 patients were included. When compared to the no-compression approach, active compression during DCCV was not associated with any significant difference in cardioversion success (RR: 1.10; 95% CI [0.96, 1.25], p = 0.16), first shock success (RR: 1.62; 95% CI [0.94, 2.81], p = 0.08), number of shocks (MD: -0.32; 95% CI [-1.01, 0.36], p = 0.36), or crossover success (MD: 0.76; 95% CI [0.33, 1.77], p = 0.52). However, active compression was associated with a reduced successful shock energy (MD: -23.97 J; 95% CI [-26.84, -21.10], p < 0.01). CONCLUSION Active compression during DCCV does not significantly improve cardioversion success but may reduce the energy required for successful cardioversion, suggesting potential safety benefits. However, further studies are needed to determine its clinical relevance.
Collapse
Affiliation(s)
| | - Abubakar Nazir
- Faculty of MedicineKing Edward Medical UniversityLahorePakistan
| | | | | | - Abdalhakim Shubietah
- Department of Internal MedicineAdvocate Illinois Masonic Medical CenterChicagoIllinoisUSA
| | | | - Sherif Sary
- Faculty of MedicineTanta UniversityTantaEgypt
| | | | - Mustafa Turkmani
- Faculty of MedicineMichigan State UniversityEast LansingMichiganUSA
- Department of Internal MedicineMcLaren Health CareOaklandMichiganUSA
| | | |
Collapse
|
2
|
Rienstra M, Tzeis S, Bunting KV, Caso V, Crijns HJGM, De Potter TJR, Sanders P, Svennberg E, Casado-Arroyo R, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Schnabel RB, Suwalski P, Tamargo J, Tica O, Traykov V, Kotecha D, Van Gelder IC. Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects. Europace 2024; 26:euae298. [PMID: 39716733 PMCID: PMC11666470 DOI: 10.1093/europace/euae298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 11/22/2024] [Indexed: 12/25/2024] Open
Abstract
Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines. The AF-CARE framework is introduced, a structural approach that aims to improve patient care and outcomes, comprising of four pillars: [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, and [E] Evaluation and dynamic reassessment. Additionally, graphical patient pathways are provided to enhance clinical application. A significant shift is the new emphasis on comorbidity and risk factor control to reduce AF recurrence and progression. Individualized assessment of risk is suggested to guide the initiation of oral anticoagulation to prevent thromboembolism. New guidance is provided for anticoagulation in patients with trigger-induced and device-detected sub-clinical AF, ischaemic stroke despite anticoagulation, and the indications for percutaneous/surgical left atrial appendage exclusion. AF ablation is a first-line rhythm control option for suitable patients with paroxysmal AF, and in specific patients, rhythm control can improve prognosis. The AF duration threshold for early cardioversion was reduced from 48 to 24 h, and a wait-and-see approach for spontaneous conversion is advised to promote patient safety. Lastly, strong emphasis is given to optimize the implementation of AF guidelines in daily practice using a patient-centred, multidisciplinary and shared-care approach, with the simultaneous launch of a patient version of the guideline.
Collapse
Affiliation(s)
- Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | - Karina V Bunting
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia-University of Perugia, Perugia, Italy
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Emma Svennberg
- Department of Medicine Karolinska University Hospital (MedH), Karolinska Institutet, Stockholm, Sweden
| | - Ruben Casado-Arroyo
- Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Luigina Guasti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Division of Geriatrics and Clinical Gerontology, ASST-Settelaghi, Varese, Italy
| | - Thorsten Hanke
- Clinic For Cardiac Surgery, Asklepios Klinikum, Harburg, Hamburg, Germany
| | - Tiny Jaarsma
- Department of Cardiology, Linkoping University, Linkoping, Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maddalena Lettino
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maja-Lisa Løchen
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK
- Saint Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- University College Hospital, University College London Hospitals NHS Trust, London, UK
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - Giuseppe M C Rosano
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy
- Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
- Cardiovascular Academic Group, St George’s University Medical School, London, UK
| | - Renate B Schnabel
- Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Piotr Suwalski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Juan Tamargo
- Pharmacology and Toxicology School of Medicine, Universidad Complutense, Madrid, Spain
| | - Otilia Tica
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, Emergency County Clinical Hospital of Bihor, Oradea, Romania
| | - Vassil Traykov
- Department of Invasive Electrophysiology, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| |
Collapse
|
3
|
Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 441] [Impact Index Per Article: 441.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
|
4
|
Ćwiertnia M, Dutka M, Białoń P, Szlagor M, Stasicki A, Mikulska M, Hajduga MB, Bobiński R, Kawecki M, Ilczak T. What Mistakes Can Be Made When Performing the Electrical Cardioversion Procedure?-Analysis of Emergency Medical Team Performance during the Championships in Emergency Medicine. Healthcare (Basel) 2024; 12:1724. [PMID: 39273748 PMCID: PMC11394996 DOI: 10.3390/healthcare12171724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a shock is delivered. Therefore, this mode must be switched on again before subsequent shocks are delivered. The main aim of the study was to assess the ability of emergency medical teams participating in emergency medicine championships to perform EC. METHODS The research was a retrospective observational study and was based on an analysis of the evaluation sheets from two tasks simulating the management of a patient with unstable tachycardia conducted during the International Winter Emergency Medicine Championships. Three-person teams consisting of paramedics and representing the Polish emergency services were included in the study. The team representing the championship organiser and the few foreign teams participating in the competition were excluded from the study. RESULTS The decision to conduct EC was taken by 36 teams (83.72%) in 2015 and 27 teams (87.10%) in 2019. In both editions of the championships, during consecutive shocks, the percentage of actions performed correctly decreased significantly-switching on synchronisation mode in 2015 (94.4%, 83.33%, 72.22%) and in 2019 (100%, 88.89%, 81.48%); correct energies in 2015 (91.67%, 80.56%, 77.78%) and in 2019 (92.59%, 85.19%, 81.48%); shocks in a safe manner in 2015 (94.44%, 94.44%, 91.67%) and in 2019 (100%, 96.30%, 96.30%). CONCLUSIONS Teams participating in the assessed tasks in a significant majority of cases correctly qualified the patient for EC, and correctly carried out the actions required for this procedure. It is of particular note that with every subsequent shock, the percentage of shocks carried out without the sync mode increased significantly.
Collapse
Affiliation(s)
- Michał Ćwiertnia
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
- European Pre-Hospital Research Network, Nottingham NG11 8NS, UK
| | - Mieczysław Dutka
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Piotr Białoń
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Michał Szlagor
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Arkadiusz Stasicki
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Monika Mikulska
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Maciej B Hajduga
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Rafał Bobiński
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Marek Kawecki
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Tomasz Ilczak
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
- European Pre-Hospital Research Network, Nottingham NG11 8NS, UK
| |
Collapse
|
5
|
Kłosiewicz T, Cholerzyńska H, Zasada WA, Shadi A, Olszewski J, Konieczka P, Podlewski R, Puślecki M. Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications-3 Years of a Single-Center Experience. J Clin Med 2023; 13:190. [PMID: 38202197 PMCID: PMC10779744 DOI: 10.3390/jcm13010190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia presenting in emergency departments (EDs), vastly increasing mainly due to society's lifestyles leading to numerous comorbidities. Its management depends on many factors and is still not unified. Aims: The aim of this study was to compare different AF management strategies in the ED and to evaluate their influence on the length of stay (LOS) in the ED and their safety. We analyzed medical records over 3 years of data collection, including age, primary AF diagnosis, an attempt to restore sinus rhythm, complications, and length of stay. Patients were divided into three groups according to the treatment method received: only pharmacological cardioversion (MED), only electrical cardioversion (EC), and patients who received medications followed by electrical cardioversion (COMB). We included 599 individuals in the analysis with a median age of 71. The restoration of sinus rhythm and LOS were as follows: MED: 64.95%, 173 min; COMB: 87.91%, 295 min; SH: 92.40%, 180 min. The difference between the MED and EC strategies, as well as MED and COMB, was statistically significant (p < 0.001 in both). The total number of complications was 16, with a rate of 32.67%. The majority of them followed a drug administration, and the most common complication was bradycardia. Electrical cardioversion is a safe and effective treatment strategy in stable patients with AF in the ED. It is associated with a shortened LOS. Medication administration preceded the majority of complications.
Collapse
Affiliation(s)
- Tomasz Kłosiewicz
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Hanna Cholerzyńska
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Wiktoria Antonina Zasada
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Amira Shadi
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Jakub Olszewski
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Patryk Konieczka
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Roland Podlewski
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Mateusz Puślecki
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| |
Collapse
|
6
|
Hashem AM, Al Ali O, Khalouf A, Shehadah A, Mohammed M, Mahmoud A, Laguio-Vila M, Rao M. Shocked to death: a case report of cardiogenic shock and death following electrocardioversion for atrial fibrillation. BMC Cardiovasc Disord 2023; 23:350. [PMID: 37452312 PMCID: PMC10349499 DOI: 10.1186/s12872-023-03376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is prevalent, especially in patients with heart failure. Their prevalence increases with age and both conditions are interrelated. Electrocardioversion (ECV) is considered a safe and effective procedure and is among one of the recommended therapies to terminate AF back to normal sinus rhythm. Our study highlights one of the rare complications following ECV. A 71-year-old female with a history of atrial fibrillation underwent electrocardioversion and developed sudden onset of ventricular stunning resulting in refractory cardiogenic shock. She was treated with mechanical cardiac support including IABP and Impella. Both provided minimal support then rapid clinical deterioration happened leading to imminent death. CONCLUSION Patients with atrial fibrillation and heart failure treated with electrocardioversion might develop refractory cardiogenic shock and death as a complication of this procedure.
Collapse
Affiliation(s)
- Anas Mohamad Hashem
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA.
| | - Omar Al Ali
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Amani Khalouf
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Ahmed Shehadah
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Moghniuddin Mohammed
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Amir Mahmoud
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Maryrose Laguio-Vila
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Mohan Rao
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, 14621, USA
| |
Collapse
|
7
|
Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 441] [Impact Index Per Article: 147.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
8
|
Alsagaff MY, Susilo H, Pramudia C, Juzar DA, Amadis MR, Julario R, Raharjo SB, Dharmadjati BB, Lusida TTE, Azmi Y, Doevendans PAFM. Rapid Atrial Fibrillation in the Emergency Department. Heart Int 2022; 16:12-19. [PMID: 36275348 PMCID: PMC9524843 DOI: 10.17925/hi.2022.16.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/13/2022] [Indexed: 01/13/2024] Open
Abstract
Atrial fibrillation (AF) is the most common rhythm disorder seen in doctors' offices and emergency departments (EDs). In both settings, an AF holistic pathway including anticoagulation or stroke avoidance, better symptom management, and cardiovascular and comorbidity optimization should be followed. However, other considerations need to be assessed in the ED, such as haemodynamic instability, the onset of AF, the presence of acute heart failure and pre-excitation. Although the Advanced Cardiovascular Life Support guidelines (European Society of Cardiology guidelines, Acute Cardiac Care Association/European Heart Rhythm Association position statements) and several recent AF publications have greatly assisted physicians in treating AF with rapid ventricular response in the ED, further practical clinical guidance is required to improve physicians' skill and knowledge in providing the best treatment for patients. Herein, we combine multiple strategies with supporting evidence-based treatment and experiences encountered in clinical practice into practical stepwise approaches. We hope that the stepwise algorithm may assist residents and physicians in managing AF in the ED.
Collapse
Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Christian Pramudia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Muhammad Rafdi Amadis
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Rerdin Julario
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Sunu Budhi Raharjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Budi Baktijasa Dharmadjati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Terrence Timothy Evan Lusida
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Yusuf Azmi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Pieter AFM Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
9
|
Stiell IG, Eagles D, Nemnom MJ, Brown E, Taljaard M, Archambault PM, Birnie D, Borgundvaag B, Clark G, Davis P, Godin D, Hohl C, Mathieu B, McRae AD, Mercier E, Morris J, Parkash R, Perry JJ, Rowe BH, Thiruganasambandamoorthy V, Scheuermeyer F, Sivilotti MLA, Vadeboncoeur A. Adverse Events Associated With Electrical Cardioversion in Patients With Acute Atrial Fibrillation and Atrial Flutter. Can J Cardiol 2021; 37:1775-1782. [PMID: 34474123 DOI: 10.1016/j.cjca.2021.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND We sought to evaluate safety of electrical cardioversion (ECV) for patients with acute atrial fibrillation (AF) or atrial flutter (AFL) in the emergency department (ED). METHODS This was an analysis of data from 4 multicentre AF/AFL studies conducted from 2008 to 2019 at 23 large EDs. We included adult patients who received attempts at ECV and who had presented acutely after symptom onset. Staff manually reviewed study and clinical records to abstract data. RESULTS We evaluated 1736 ECV cases with a mean age of 60.1 years and 67.1% male. The overall success of ECV was 90.2% (95% confidence interval 88.7%-91.6%), with 4.9% of patients admitted. ED physicians performed the ECV in 95.2% and provided sedation in 96.5%; 13.9% (12.3%-15.7%) of cases experienced important adverse events that required treatment, and 0.4% were classified as life threatening. Another 5.6% had adverse events that did not require treatment. Logistic regression found that the RAFF-3 study cohort (odds ratio [OR] 2.0), age ≥ 85 years (OR 2.1), coronary artery disease (OR 1.5), midazolam (OR 1.9), and fentanyl (OR 1.5) were associated with important adverse events. CONCLUSIONS This large evaluation of the safety of ECV for acute AF/AFL in the ED found that while serious adverse events were rare, there were a concerning number of events following sedation that required intervention. Physicians should be aware that older age, coronary artery disease, and fentanyl are associated with higher risks of important adverse events. This study provides more information for shared decision making discussions with patients when choosing between drug-shock and shock-only cardioversion strategies.
Collapse
Affiliation(s)
- Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erica Brown
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Patrick M Archambault
- Département de Médecine Familiale et de Médicine d'Urgence, Centre de Recherche du Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada; Département d'Anesthésiologie et de Soins Intensifs, Centre de Recherche du Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada
| | - David Birnie
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Bjug Borgundvaag
- Division of Emergency Medicine, University of Toronto, Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Gregory Clark
- Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Philip Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Corinne Hohl
- Department of Emergency Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernard Mathieu
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Montréal, Montréal, Québec, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric Mercier
- Department of Emergency Medicine, Centre for Clinical Epidemiology and Evaluation, Université Laval, Québec City, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Centre de Recherche du CHU de Québec, Université Laval, Québec City, Québec, Canada
| | - Judy Morris
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Montréal, Montréal, Québec, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Dalhousie University, Dartmouth, Nova Scotia, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marco L A Sivilotti
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alain Vadeboncoeur
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
10
|
Wong BM, Perry JJ, Cheng W, Zheng B, Guo K, Taljaard M, Skanes AC, Stiell IG. Thromboembolic events following cardioversion of acute atrial fibrillation and flutter: a systematic review and meta-analysis. CAN J EMERG MED 2021; 23:500-511. [PMID: 33715143 DOI: 10.1007/s43678-021-00103-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent studies have presented concerning data on the safety of cardioversion for acute atrial fibrillation and flutter. We conducted this meta-analysis to evaluate the effect of oral anticoagulation use on thromboembolic events post-cardioversion of low-risk acute atrial fibrillation and flutter patients of < 48 h in duration. METHODS We searched MEDLINE, Embase, and Cochrane from inception through February 6, 2020 for studies reporting thromboembolic events post-cardioversion of acute atrial fibrillation and flutter. Main outcome was thromboembolic events within 30 days post-cardioversion. Primary analysis compared thromboembolic events based on oral anticoagulation use versus no oral anticoagulation use. Secondary analysis was based on baseline thromboembolic risk. We performed meta-analyses where 2 or more studies were available, by applying the DerSimonian-Laird random-effects model. Risk of bias was assessed with the Quality in Prognostic Studies tool. RESULTS Of 717 titles screened, 20 studies met inclusion criteria. Primary analysis of seven studies with low risk of bias demonstrated insufficient evidence regarding the risk of thromboembolic events associated with oral anticoagulation use (RR = 0.82 where RR < 1 suggests decreased risk with oral anticoagulation use; 95% CI 0.27 to 2.47; I2 = 0%). Secondary analysis of 13 studies revealed increased risk of thromboembolic events with high baseline thromboembolic risk (RR = 2.25 where RR > 1 indicates increased risk with higher CHADS2 or CHA2DS2-VASc scores; 95% CI 1.25 to 4.04; I2 = 0%). CONCLUSION Primary analysis revealed insufficient evidence regarding the effect of oral anticoagulation use on thromboembolic events post-cardioversion of low-risk acute atrial fibrillation and flutter, though the event rate is low in contemporary practice. Our findings can better inform patient-centered decision-making when considering 4-week oral anticoagulation use for acute atrial fibrillation and flutter patients.
Collapse
Affiliation(s)
- Brenton M Wong
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bo Zheng
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin Guo
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Allan C Skanes
- Division of Cardiology, Western University, London, ON, Canada
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Clinical Epidemiology Unit, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| |
Collapse
|
11
|
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 6324] [Impact Index Per Article: 1581.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
13
|
Velázquez-Rodríguez E, Pérez-Sandoval HA, Rangel-Rojo FJ. Orthogonal electrical cardioversion in atrial fibrillation refractory to biphasic shocks: a case series. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33442616 PMCID: PMC7793132 DOI: 10.1093/ehjcr/ytaa343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/12/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022]
Abstract
Background Biphasic waveform shock has been established as the standard method for cardioversion of atrial fibrillation (AF). Depending on various factors, standard electrical cardioversion for AF may be unsuccessful in some cases, even with biphasic shocks. Case summary We report the safety and efficacy of orthogonal electrical cardioversion (OECV) as an alternative in patients with paroxysmal AF refractory to standard biphasic electrical cardioversion after up to three subsequent shocks of increasing energy and/or two or three initial shocks with maximum energy of 200-Joules. Shocks were delivered with two external defibrillators via two sets of adhesive electrode pads to apply two perpendicular electrical vectors in a simultaneous-sequential mode in antero-lateral and antero-posterior configuration. Five patients, mean age 54.4 ± 11, three with hypertensive heart disease and a body mass index 27.2 ± 2 kg/m2. All individual mean impedance before OECV was 79 ± 5 Ω with a mean peak current applied of 22 ± 4.5 A. Restoration of sinus rhythm with OECV was achieved acutely and sustained in all five patients. No patients developed haemodynamic instability or thromboembolic events. Discussion Double simultaneous shocks in an orthogonal configuration could theoretically decrease the defibrillation threshold through the ability of sequential pulses applying a more efficient and uniform current density. OECV using lower/medium energy may be another useful rescue strategy in AF refractory to standard biphasic shocks.
Collapse
Affiliation(s)
- Enrique Velázquez-Rodríguez
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Subdirección de Servicios de Salud, Hospital Central Norte, Pemex, Universidad Nacional Autónoma de México, Campo Matillas 52, Col. San Antonio, 02720 Ciudad de México, Mexico
| | - Hipólito Alfredo Pérez-Sandoval
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Subdirección de Servicios de Salud, Hospital Central Norte, Pemex, Universidad Nacional Autónoma de México, Campo Matillas 52, Col. San Antonio, 02720 Ciudad de México, Mexico
| | - Francisco Javier Rangel-Rojo
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Subdirección de Servicios de Salud, Hospital Central Norte, Pemex, Universidad Nacional Autónoma de México, Campo Matillas 52, Col. San Antonio, 02720 Ciudad de México, Mexico
| |
Collapse
|
14
|
Saglietto A, De Ferrari GM, Gaita F, Anselmino M. Short-term anticoagulation after acute cardioversion of early-onset atrial fibrillation. Eur J Clin Invest 2020; 50:e13316. [PMID: 32535904 DOI: 10.1111/eci.13316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Controversy exists regarding anticoagulation management following acute cardioversion in patients with early-onset (<48 hours) atrial fibrillation without class I guideline indication for long-term oral anticoagulation (CHA2DS2-VASc 0-1). METHODS AND RESULTS A random-effect meta-analysis of observational studies reporting 30-day incidence of thromboembolic complications after cardioversion without post-procedural oral anticoagulation therapy in patients at low-moderate thromboembolic risk (CHA2DS2-VASc 0-1) was performed. Four studies were included, encompassing 3276 cardioversions. The analysis revealed that the pooled risk of 30-day incidence of thromboembolic complications in this subset of patients is low (0.10%, 95% confidence interval: 0.00%-0.30%). CONCLUSIONS Given these data, considering the bleeding risk unavoidably conferred by OAT, which is known to be higher in the first month from treatment onset, short-term anticoagulation limited to 4 weeks post-cardioversion of early-onset (<48 hours) atrial fibrillation in patients with low-moderate risk of stroke (CHA2DS2-VASc 0-1) may be omitted, at least in patients with high-bleeding risk.
Collapse
Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino" Hospital, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino" Hospital, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Cardiovascular Department, Clinica Pinna Pintor, Policlinico di Monza, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino" Hospital, University of Turin, Turin, Italy
| |
Collapse
|
15
|
Andrade JG, Aguilar M, Atzema C, Bell A, Cairns JA, Cheung CC, Cox JL, Dorian P, Gladstone DJ, Healey JS, Khairy P, Leblanc K, McMurtry MS, Mitchell LB, Nair GM, Nattel S, Parkash R, Pilote L, Sandhu RK, Sarrazin JF, Sharma M, Skanes AC, Talajic M, Tsang TSM, Verma A, Verma S, Whitlock R, Wyse DG, Macle L. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation. Can J Cardiol 2020; 36:1847-1948. [PMID: 33191198 DOI: 10.1016/j.cjca.2020.09.001] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.
Collapse
Affiliation(s)
- Jason G Andrade
- University of British Columbia, Vancouver, British Columbia, Canada; Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Martin Aguilar
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Alan Bell
- University of Toronto, Toronto, Ontario, Canada
| | - John A Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jafna L Cox
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Dorian
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Paul Khairy
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Girish M Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stanley Nattel
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Jean-François Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Mukul Sharma
- McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Mario Talajic
- Montreal Heart Institute, University of Montreal, Montréal, Quebec, Canada
| | - Teresa S M Tsang
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Laurent Macle
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | |
Collapse
|
16
|
Yaman B, Cerit L, Günsel HK, Cerit Z, Usalp S, Yüksek Ü, Coşkun U, Duygu H, Akpınar O. Is there any Link Between Vitamin D and Recurrence of Atrial Fibrillation after Cardioversion? Braz J Cardiovasc Surg 2020; 35:191-197. [PMID: 32369300 PMCID: PMC7199985 DOI: 10.21470/1678-9741-2019-0166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is the most common chronic arrhythmia in the elderly population. In symptomatic patients, restoration and maintenance of sinus rhythm improve quality of life. Unfortunately, AF recurrence still occurs in a considerable number of patients after cardioversion (CV). In this study, we aimed to evaluate the association between vitamin D (VitD) and AF recurrence after electrical or medical CV. Method A total of 51 patients who underwent CV for symptomatic AF were included in the study. AF recurrence was defined as an AF pattern in 12-lead electrocardiography (ECG) recording after CV within 6 months or ECG Holter recording of AF lasting more than 30 seconds at 6-month follow-up. Results Mean vitD level was 21.4 ng/ml in our study population. VitD level was lower in the AF recurrence group than in the non-recurrence group (18 ng/ml vs. 26.3 ng/ml, respectively; P=0.001). Additionally, left atrial diameter was larger in the AF recurrence group compared to the non-recurrence group (4.4 vs. 4.1, P=0.025). Patients with AF recurrence were older than patients without AF recurrence, and, although the prevalence of hypertension is higher in the AF recurrence group, there was no statistically significant difference (P=0.107, P=0.867). Conclusion In our study, there is a strong association between vitD level and AF recurrence after CV. VitD deficiency might be a predictor of high risk of AF recurrence after CV and vitD supplementation during the follow-up might help the maintenance of sinus rhythm.
Collapse
Affiliation(s)
- Belma Yaman
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Levent Cerit
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Hatice Kemal Günsel
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Zeynep Cerit
- Near East University Department of Pediatric Cardiology Nicosia Cyprus Department of Pediatric Cardiology, Near East University, Nicosia, Cyprus
| | - Songül Usalp
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Ümit Yüksek
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Uğur Coşkun
- University of Kyrenia Faculty of Medicine Department of Cardiology Kyrenia Cyprus Department of Cardiology, University of Kyrenia Faculty of Medicine, Kyrenia, Cyprus
| | - Hamza Duygu
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| | - Onur Akpınar
- Near East Faculty of Medicine Department of Cardiology Nicosia Cyprus Department of Cardiology, Near East Faculty of Medicine, Nicosia, Cyprus
| |
Collapse
|
17
|
Bonfanti L, Lippi G, Donelli V, Pigna F, Saccenti C, Cervellin G. Is anticoagulant therapy always indicated in "medium-risk" patients with first diagnosed atrial fibrillation? Insights from a real world, 10-year observational study. Int J Cardiol 2019; 288:76-81. [PMID: 31047700 DOI: 10.1016/j.ijcard.2019.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The choice of antithrombotic prophylaxis in the so-called "medium-risk" patients (i.e., CHA2DS2-VASc score = 1 in males or 2 in females) is one of the major enigmatic issues in clinical management of atrial fibrillation (AF). METHODS We retrospectively evaluated 30-day and 1-year thromboembolic events in all consecutive medium-risk patients visited for first diagnosed AF in the local Emergency Department during a 10-year period. The main aim was to establish whether anticoagulant or antiplatelet therapy was effective to lower the thromboembolic risk in patients receiving these drugs. Bleeding events, related to anticoagulant or antiplatelet therapy, was defined as secondary end point. RESULTS The final study population consisted of 6389 (3640 males and 2749 females) patients for whom a complete dataset regarding targeted follow-up was available. Patients were then subdivided into two subgroups, according to performance of cardioversion and spontaneous sinus rhythm restoring. In both genders, no significant difference in thromboembolic or bleeding events was noted between patients who underwent cardioversion and were discharged with oral anticoagulant therapy or antiplatelet treatment versus those who were not treated with antithrombotic drugs. Moreover, no difference was also observed in thromboembolic or hemorrhagic event rate between low risk and "medium-risk" patients. CONCLUSIONS The results of this study suggest that anticoagulant or antiplatelet therapy would not produce clinical benefits in "medium-risk" AF patients.
Collapse
Affiliation(s)
- Laura Bonfanti
- Emergency Department, University Hospital of Parma, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Valentina Donelli
- Postgraduate Emergency Medicine School, University of Parma, Parma, Italy
| | - Federica Pigna
- Emergency Department, University Hospital of Parma, Italy
| | | | | |
Collapse
|