title: Long-term outcome of electrical cardioversion in patients with chronic atrial flutter.
abstract: OBJECTIVE
  To determine the long-term outcome of serial electrical cardioversion therapy in patients with chronic atrial flutter.
  
  
  METHODS
  Prospective study, case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  50 consecutive patients with chronic (> 24 hours) atrial flutter without a previous relapse on antiarrhythmic drugs.
  
  
  METHODS
  Elective electrical cardioversion therapy, if necessary repeated, to obtain and keep patients in sinus rhythm. If the first cardioversion resulted in sinus rhythm, patients were not given antiarrhythmic drugs. Relapses were managed by repeated cardioversions then anti-arrhythmic drugs were used serially in a set sequence.
  
  
  METHODS
  Maintenance of sinus rhythm.
  
  
  RESULTS
  Mean (SD) follow up was 3.5 (1.7) years. The first cardioversion was successful in 48 patients (96%). After a single shock and without antiarrhythmic drugs being used, 42% of the patients maintained sinus rhythm in the long-term. Only left atrial size was inversely related to the efficacy of one shock (P = 0.025). With serial cardioversion 90% of the patients were kept in sinus rhythm for 5 years. Univariate analysis showed that a long duration of arrhythmia and impaired cardiac function were both related to poor outcome. During follow up 3 patients died of progression of heart failure and another 5 died suddenly. None of these 5 patients was on antiarrhythmic drugs.
  
  
  CONCLUSIONS
  Electrical cardioversion was an effective and safe method of converting chronic atrial flutter to sinus rhythm. To maintain sinus rhythm, more than half of the patients required multiple shocks and prophylactic antiarrhythmic drugs. Sudden death was relatively frequent in the study population; the limited data available from this study suggest that such deaths were caused by the underlying disease and not drug related proarrhythmia.
authors.affiliation: Department of Cardiology, University Hospital Groningen, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Crijns
authors.forename: I C
authors.initials: IC
authors.lastname: Van Gelder
authors.forename: R G
authors.initials: RG
authors.lastname: Tieleman
authors.forename: J
authors.initials: J
authors.lastname: Brügemann
authors.forename: P J
authors.initials: PJ
authors.lastname: De Kam
authors.forename: A T
authors.initials: AT
authors.lastname: Gosselink
authors.forename: M T
authors.initials: MT
authors.lastname: Bink-Boelkens
authors.forename: K I
authors.initials: KI
authors.lastname: Lie
mesh_terms: D001282:Atrial Flutter / Q000628:therapy*; D002908:Chronic Disease; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome