title: Cardiovascular Events of Electrical Cardioversion Under Optimal Anticoagulation in Atrial Fibrillation: The Multicenter Analysis.
abstract: OBJECTIVE
  Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale study about the acute cardiovascular events following electrical cardioversion of AF is lacking. This study was performed to evaluate the incidence, risk factors, and clinical consequences of acute cardiovascular events following electrical cardioversion of AF.
  
  
  METHODS
  The study enrolled 1100 AF patients (mean age 60±11 years) who received cardioversion at four tertiary hospitals. Hospitalizations for stroke/transient ischemic attack, major bleedings, and arrhythmic events during 30 days post electric cardioversion were assessed.
  
  
  RESULTS
  The mean duration of anticoagulation before cardioversion was 95.8±51.6 days. The mean International Normalized Ratio at the time of cardioversion was 2.4±0.9. The antiarrhythmic drugs at the time of cardioversion were class I (45%), amiodarone (40%), beta-blocker (53%), calcium-channel blocker (21%), and other medication (11%). The success rate of terminating AF via cardioversion was 87% (n=947). Following cardioversion, 5 strokes and 5 major bleedings occurred. The history of stroke/transient ischemic attack (OR 6.23, 95% CI 1.69-22.90) and heart failure (OR 6.40, 95% CI 1.77-23.14) were among predictors of thromboembolic or bleeding events. Eight patients were hospitalized for bradyarrhythmia. These patients were more likely to have had a lower heart rate prior to the procedure (p=0.045). Consequently, 3 of these patients were implanted with a permanent pacemaker.
  
  
  CONCLUSIONS
  Cardioversion appears as a safe procedure with a reasonably acceptable cardiovascular event rate. However, to prevent the cardiovascular events, several risk factors should be considered before cardioversion.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong Geum
authors.initials: DG
authors.lastname: Shin
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Iksung
authors.initials: I
authors.lastname: Cho
authors.affiliation: Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.|Department of Internal Medicine/Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, CT, USA.
authors.forename: Bríain ó
authors.initials: Bó
authors.lastname: Hartaigh
authors.affiliation: Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
authors.forename: Hee-Sun
authors.initials: HS
authors.lastname: Mun
authors.affiliation: Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
authors.forename: Eui Seock
authors.initials: ES
authors.lastname: Hwang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin-Kyu
authors.initials: JK
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D001919:Bradycardia / Q000453:epidemiology / Q000209:etiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
keywords: Atrial fibrillation; cardiovascular events; cardioversion; safety