Early direct current cardioversion or ablation for atrial fibrillation or atrial flutter and acute decompensated heart failure.

Publisher: Pasifika Medical Association Group Country of Publication: New Zealand NLM ID: 0401067 Publication Model: Electronic Cited Medium: Internet ISSN: 1175-8716 (Electronic) Linking ISSN: 00288446 NLM ISO Abbreviation: N Z Med J Subsets: MEDLINE

Publication: 2022- : Auckland : Pasifika Medical Association Group
Original Publication: Wellington : New Zealand Medical Association

Atrial Fibrillation/*therapy ; Atrial Flutter/*therapy ; Catheter Ablation/*methods ; Echocardiography, Transesophageal/*methods ; Electric Countershock/*methods; Aged ; Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/mortality ; Atrial Flutter/diagnostic imaging ; Atrial Flutter/mortality ; Catheter Ablation/mortality ; Chi-Square Distribution ; Cohort Studies ; Echocardiography/methods ; Electric Countershock/mortality ; Female ; Heart Failure/prevention & control ; Humans ; Male ; Middle Aged ; New Zealand ; Patient Readmission/statistics & numerical data ; Patient Selection ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Statistics, Nonparametric ; Survival Rate ; Treatment Outcome

Aims: Guidelines recommend initial rate control in haemodynamically stable patients with atrial fibrillation (AF) or atrial flutter (AFL) and acute decompensated heart failure (ADHF). There is limited data on early inpatient rhythm control. We investigated the outcomes of patients managed with early TOE-guided DC cardioversion (DCCV) or ablation.
Methods: We retrospectively analysed patients admitted to a single centre with AF or AFL and ADHF with LVEF≤40% that underwent inpatient TOE-guided DCCV or ablation. The primary endpoint was the one year composite outcome of mortality or rehospitalisation for heart failure.
Results: We identified 79 patients, including 33 with AF (32 DCCV, one ablation) and 46 with AFL (22 DCCV, 24 ablation). The primary endpoint occurred in 20%. One-year mortality was 2.5%. There were significantly fewer rehospitalisations for arrhythmia or heart failure with AFL-ablation compared to AFL-DCCV (21% vs 64%, p=<0.01). Clinical recurrence of AF or AFL was 43%. At follow-up LV assessment, LVEF>40% was found in 75% (p=<0.01), including 87% of patients without known cardiomyopathy and 82% of patients in sinus rhythm.
Conclusion: Early inpatient DCCV or ablation for AF or AFL and ADHF had low mortality rates and rehospitalisation for heart failure with substantial improvement in LV function at follow-up.
Competing Interests: Nil.

Date Created: 20190607 Date Completed: 20200114 Latest Revision: 20200114

20221213

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