title: Sex, age, and time to cardioversion. Risk factors for cardioversion of acute atrial fibrillation from the FinCV study.
abstract: Female sex, old age, and time to cardioversion increase the risk of thromboembolic complications (TEC) after cardioversion of atrial fibrillation (AF) < 48 h. The interaction of these variables is not known. We investigated the interaction of sex, age, and time to electrical cardioversion (ECV) on TEC in anticoagulant-naive patients with acute AF.
  
  
  
  The primary outcome was a TEC within 30 days following ECV. Patients were divided into three age groups and time to cardioversion into <12 h and ≥12 h in 4715 ECVs. TEC occurred in 40 (0.8%) patients. In multivariate analysis, female sex, time to ECV, and vascular disease were independent predictors of TEC. For patients ≤75 cardioverted within 12 h, the incidence of TEC was low. In patients >75 TEC increased in both sexes and particularly in women (1.4% vs. 0.9%, p = 0.03). When ECVs exceeded 12 h, the risk of TEC was two- to four-fold higher in women in all age groups.
  
  
  
  The risk of TEC increases substantially in patients >75 and ECVs ≥12 h, particularly in women. Time to cardioversion should be added to risk-stratification of ECVs of acute AF. Key messages The ideal timing of cardioversion is still unknown and not based on solid evidence. Delay to cardioversion ≥12 h should be added to the risk stratification of atrial fibrillation cardioversion. Female sex increases the risk of complications and failure of cardioversion after electrical cardioversion of atrial fibrillation <48 h, especially with age >75 years and time to cardioversion exceeding 12 h.
authors.affiliation: a Heart Center, Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland.
authors.forename: Aissa
authors.initials: A
authors.lastname: Bah
authors.affiliation: b Department of Acute Internal Medicine , Turku University Hospital , Turku , Finland.
authors.forename: Ilpo
authors.initials: I
authors.lastname: Nuotio
authors.affiliation: c Heart Center, Turku University Hospital and University of Turku , Turku , Finland.
authors.forename: Toni
authors.initials: T
authors.lastname: Grönberg
authors.affiliation: c Heart Center, Turku University Hospital and University of Turku , Turku , Finland.|d Satakunta Central Hospital , Pori , Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Ylitalo
authors.affiliation: c Heart Center, Turku University Hospital and University of Turku , Turku , Finland.
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
authors.affiliation: a Heart Center, Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland.
authors.forename: Juha E K
authors.initials: JE
authors.lastname: Hartikainen
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D004554:Electric Countershock / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013923:Thromboembolism / Q000150:complications; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Age; atrial fibrillation; electrical cardioversion; female sex; time to cardioversion