Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice.
BACKGROUND
The purpose of the present study was to assess the trends in the use of ECV following published studies that had compared rhythm and rate control strategies on atrial fibrillation (AF), and the recommendations included in the current clinical practice guidelines.


METHODS
The REVERCAT is a population-based assessment of the use of electrical cardioversion (ECV) in treating persistent AF in Catalonia (Spain). The initial survey was conducted in 2003 and the follow-up in 2010.


RESULTS
We observed a decrease of 9% in the absolute numbers of ECV performed (436 in 2003 vs. 397 in 2010). This is equivalent to 27% when considering population increases over this period. The patients treated with ECV in 2010 were younger, had a lower prevalence of previous embolism, a higher prevalence of diabetes, and increased body weight. Underlying heart disease factors indicated, in 2010, a higher proportion of NYHA ≥ II and left ventricular ejection fraction <30%. We observed a reduction in the number of ECV performed in 16 of the 27 (67%) participating hospitals. However, there was an increase of 14% in the number of procedures performed in tertiary hospitals, and was related to the increasing use of ECV as a bridge to AF ablation. Considering the initial number of patients treated with ECV, the rate of sinus rhythm at 3 months was almost unchanged (58% in 2003 vs. 57% in 2010; p=0.9) despite the greater use of biphasic energy in 2010 and a similar prescription of anti-arrhythmic drugs.


CONCLUSIONS
Although we observed a decrease in the number of ECVs performed over the 7 year period between the two studies, this technique remains a common option for treating patients with persistent AF. The change in the characteristics of candidate patients did not translate into better outcomes.
Secció de Cardiologia, Hospital Universitari de Sant Joan, Institut d'Investigacions Sanitàries Pere Virgili, Universitat Rovira i Virgili, C/Dr, Laporte, s/n, Reus, 43205, Spain. txalegret@hotmail.com
Josep M
JM
Alegret
Xavier
X
Viñolas
César
C
Romero-Menor
Silvia
S
Pons
Roger
R
Villuendas
Naiara
N
Calvo
Jordi
J
Pérez-Rodon
Xavier
X
Sabaté
D000367:Age Factors; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D015897:Comorbidity; D004554:Electric Countershock / Q000639:trends*; D019317:Evidence-Based Medicine / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents