[Therapeutic success of a prospective cardioversion protocol for persistent atrial fibrillation].
OBJECTIVE
The best therapeutic approach for persistent atrial fibrillation has yet to be defined. Our aim was to investigate the effects of cardioversion in unselected patients with persistent atrial fibrillation who were treated according to a strict protocol involving pretreatment, cardioversion, and follow-up.


METHODS
Consecutive patients with persistent atrial fibrillation of at least 1 months' duration were included prospectively in a cardioversion protocol that involved standard antiarrhythmic pretreatment, with amiodarone being offered first, and follow-up.


RESULTS
The study included 295 patients, 87.5% of whom were taking the antiarrhythmic drug amiodarone. Sinus rhythm was restored in 92.5%, with pharmacologic cardioversion occurring in 9.5%. The recurrence rate was 33.5% in the first month and 54.9% by month 12. Antiarrhythmic treatment had to be modified in 10.8% of patients. Independent risk factors for recurrence during the first year after cardioversion were an atrial fibrillation duration greater than one year, previous cardioversion, and left ventricular dilatation. A simple risk scoring system was able to differentiate between subgroups of patients with a low, intermediate or high risk of recurrence in the first year after cardioversion.


CONCLUSIONS
Sinus rhythm was maintained for 1 year after effective cardioversion in 45.1% of patients who received homogeneous antiarrhythmic pretreatment. There were few side effects. Recurrence can be predicted using clinical variables such as left ventricular dilatation, arrhythmia duration, and previous cardioversion.
Martínez-Brotóns
Angel M
AM
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain. angelmmb@hotmail.com
Ruiz-Granell
Ricardo
R
Morell
Salvador
S
Plancha
Eva
E
Ferrero
Angel
A
Roselló
Araceli
A
Llácer
Angel
A
García-Civera
Roberto
R
D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D002985:Clinical Protocols; D003627:Data Interpretation, Statistical; D004554:Electric Countershock / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone