Clinical effectiveness of antiarrhythmic treatment after electrical cardioversion in patients without structural heart disease.
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.
Alegret
Josep Maria
JM
Servicio de Cardiología, Hospital de Sant Joan de Reus, Reus, Tarragona, Spain. txalegret@hotmail.com
Viñolas
Xavier
X
Grande
Angel
A
Castellanos
Eduardo
E
Asso
Antonio
A
Tercedor
Luis
L
Carmona
José Ramón
JR
Medina
Olga
O
Alberola
Arcadio García
AG
Fidalgo
Ma Luisa
ML
Pérez-Alvarez
Luisa
L
Sabaté
Xavier
X
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
D000889:Anti-Arrhythmia Agents