title: Clinical effectiveness of antiarrhythmic treatment after electrical cardioversion in patients without structural heart disease.
abstract: OBJECTIVE
  The aim was to investigate the clinical effectiveness of using antiarrhythmic drugs after electrical cardioversion in patients without structural heart disease, including their effect on the maintenance of sinus rhythm.
  
  
  METHODS
  In total, 528 patients with persistent atrial fibrillation but without significant structural heart disease who underwent successful electrical cardioversion at 96 Spanish hospitals were followed up for 1 year. Patients were assessed at 1, 3, 6 and 12 months. The use and effectiveness of antiarrhythmic drugs for preventing the recurrence of persistent atrial fibrillation was evaluated.
  
  
  RESULTS
  Some 80% of patients were receiving antiarrhythmic drugs at discharge, most frequently amiodarone. No specific clinical factor was associated with greater use of antiarrhythmics. Overall, 37% of patients were in sinus rhythm at all follow-up assessments. At the 1-year assessment, 59% of patients who remained in sinus rhythm were still taking antiarrhythmic drugs. Multivariate Cox regression analysis identified weight (hazard ratio [HR]=1.01 per kg; P=.04) and no antiarrhythmic treatment (HR=1.59; P=.001) as being independently associated with the recurrence of persistent atrial fibrillation. Amiodarone tended to be better than other antiarrhythmic drugs.
  
  
  CONCLUSIONS
  In routine clinical practice, the large majority of patients without structural heart disease received antiarrhythmic drugs, most frequently amiodarone, after successful electrical cardioversion. Drug use was the principal factor associated with the maintenance of sinus rhythm at 1 year.
authors.affiliation: Servicio de Cardiología, Hospital de Sant Joan de Reus, Reus, Tarragona, Spain. txalegret@hotmail.com
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Alegret
authors.forename: Xavier
authors.initials: X
authors.lastname: Viñolas
authors.forename: Angel
authors.initials: A
authors.lastname: Grande
authors.forename: Eduardo
authors.initials: E
authors.lastname: Castellanos
authors.forename: Antonio
authors.initials: A
authors.lastname: Asso
authors.forename: Luis
authors.initials: L
authors.lastname: Tercedor
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Carmona
authors.forename: Olga
authors.initials: O
authors.lastname: Medina
authors.forename: Arcadio García
authors.initials: AG
authors.lastname: Alberola
authors.forename: Ma Luisa
authors.initials: ML
authors.lastname: Fidalgo
authors.forename: Luisa
authors.initials: L
authors.lastname: Pérez-Alvarez
authors.forename: Xavier
authors.initials: X
authors.lastname: Sabaté
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D003131:Combined Modality Therapy; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000889:Anti-Arrhythmia Agents