title: Does antiarrhythmic drugs premedication improve electrical cardioversion success in persistent atrial fibrillation?
abstract: Aim of this study is to evaluate the impact of antiarrhythmic drugs (AADs) administration for at least one month before ECV on the acute and long term success rate of the procedure.
  
  
  
  1313 consecutive persistent AF patients were enrolled in 3 different centers (Turin, Asti and Avellino): 692 patients received AADs before and after ECV (group A), 621 patients were treated only after the procedure, at discharge (group B). Primary end point was the restoration and maintenance of sinus rhythm acutely and at a long-term follow up.
  
  
  
  Acute ECV success was higher in group A compared with group B (99% vs. 88%, p=0.0001) and a fewer number of shock attempts were administered (1.15±0.42 vs. 1.27±0.53 p<0.0001). Moreover group A maintained SR more often than group B at one month (99% vs. 89%, log-rank p<0.0001), at one year (55% vs. 48% log-rank p=0.01) and at the end of follow up (mean 2.7±2.1years, 45% vs. 29%, log-rank p<0.0001). At multivariate analysis AADs premedication was the strongest independent predictor of acute and long-term ECV success (respectively p<0.0001 OR 10.71 CI 5.10-22.50 and p=0.004, OR 1.50 CI 1.14-1.97). At sensitivity analysis no differences were found between ADDs in terms of acute success improvement (p=0.605), number of shock attempts (p=0.853) and long term SR maintenance (log-rank p=0.480).
  
  
  
  AADs administration for at least 4weeks before the ECV in persistent AF increases significantly the acute success rate and this result was maintained over a long-term follow-up.
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della salute e della scienza, University of Turin, Turin, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Toso
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della salute e della scienza, University of Turin, Turin, Italy. Electronic address: mario.iannaccone@hotmail.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Iannaccone
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Caponi
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, San Giuseppe Moscati Hospital, Avellino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rotondi
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, San Giuseppe Moscati Hospital, Avellino, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della salute e della scienza, University of Turin, Turin, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gallo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della salute e della scienza, University of Turin, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002908:Chronic Disease; D004562:Electrocardiography / Q000187:drug effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D011292:Premedication / Q000379:methods* / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antiarrhythmic drugs; Atrial fibrillation; Electrical cardioversion