title: Sinus bradycardia and sinus pauses immediately after electrical cardioversion of persistent atrial fibrillation--what do they mean?
abstract: BACKGROUND
  To determine the role of sinus bradyarrhythmia (SB) immediately after electrical cardioversion of persistent atrial fibrillation (AF) on the short-term recurrence rate and long-term pacemaker need and all-cause mortality.
  
  
  METHODS
  SB defined as sinus bradycardia (sinus rate <40 bpm for ≥2 consecutive cycles) and/or sinus pauses (>2 s), were recorded during 5 minutes immediately after successful DC cardioversion in 140 consecutive patients with persistent AF.
  
  
  RESULTS
  SB was observed during the first minute of SR in 31 patients (22%). Sinus bradycardia was present in 27 patients, sinus pauses in 16 (>3 s in 10) patients, and both in 12 patients. Compared to patients without SB, the mean heart rate during the first minute after cardioversion was lower, 57 ± 13 versus 63 ± 11 bpm; P < 0.05, while the mean heart rates during the subsequent 4 minutes were not statistically significantly different. The AF recurrence rates were not significantly different at 1 week (45% vs. 40%), or at 3 months (68% vs. 53%) in patients with or without SB. After a mean follow-up of 86 ± 6 months the pacemaker implantation rate was 10% versus 11% (NS) and an all-cause mortality of 26 versus 18% (NS).
  
  
  CONCLUSIONS
  SB immediately after electrical cardioversion of persistent AF had no significant impact on the 3-month AF recurrence rate, the long-term need for pacemaker or all-cause mortality.
authors.affiliation: Department of Cardiology, University Hopsital Örebro, Örebro, Sweden. dritan.poci@orebroll.se
authors.forename: Dritan
authors.initials: D
authors.lastname: Poçi
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Abrahamsson
authors.forename: Nils
authors.initials: N
authors.lastname: Edvardsson
authors.forename: Lennart
authors.initials: L
authors.lastname: Bergfeldt
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000628:therapy*; D001919:Bradycardia / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome