Daily Archive 16.02.2019

Electrical Cardioversion Atrial Fibrillation

In most patients with atrial fibrillation (AF), sinus rhythm can be restored with the help of electrical cardioversion, but arrhythmia often recurs. The factors that increase the likelihood of recurrence are the long duration of AF, the presence of heart failure, a significant expansion of the LP and age. One year after cardioversion, a normal rhythm is maintained in no more than a quarter of patients.

The frequency of recurrence of atrial fibrillation (AF) after cardioversion is reduced by antiarrhythmic agents such as flecainide, sotalol, propafenone, and especially amiodarone. These drugs may have undesirable effects, and in many patients their prescription should be reserved for re-cardioversion, when restoring sinus rhythm seems reasonable and dictates the need for further restoration and maintenance of sinus rhythm. Digoxin may increase the frequency of recurrences of arrhythmias.

In the long term, after cardioversion, sinus rhythm is maintained in only a small number of patients. Therefore, the question of restoring rhythm should be primarily considered in the treatment of patients with relatively recently existing arrhythmias (less than 12 months), in whom no apparent causes of its occurrence were identified or if the identified cause was resolved or resolved independently.

In case of recurrence of atrial fibrillation (AF), the next cardioversion attempt should be undertaken after initiation of antiarrhythmic therapy in patients with severe symptoms caused by arrhythmia.

There are reports of successful recovery and retention of sinus rhythm after cardioversion in one third of patients with AF, in whom the arrhythmia had a continuous course for 12-24 months. and more. In patients with difficult-to-treat AF (even long-term), cardioversion should also be considered, since there is still a small chance of restoring and maintaining sinus rhythm.

A proven effective method of restoring normal rhythm is currently the transvenous cardioversion. A higher incidence of successful treatment was reported than with transthoracic cardioversion, especially when treating large patients. In most patients, cardioversion is performed as planned, but sometimes emergency cardioversion is required for hemodynamically unstable patients.