title: Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study.
abstract: Elective cardioversion (ECV) of atrial fibrillation (AF) is a standard procedure to restore sinus rhythm. However, predictors for ineffective ECV (failure of ECV or recurrence of AF within 30 days) are unknown.
  
  
  
  We investigated 1998 ECVs performed for AF lasting >48 h in 1,342 patients in a retrospective multi-center study. Follow-up data were collected from 30 days after ECV.
  
  
  
  Median number of cardioversions was one per patient with a range of 1-10. Altogether 303/1998 (15.2%) ECVs failed. Long (>5 years) AF history and over 30 days duration of the index AF episode were independent predictors for ECV failure and low (<60/min) ventricular rate of AF predicted success of ECV. In patients with successful ECVs an early recurrence of AF was detected in 549 (32.4%) cases. Female gender, high (>60/min) ventricular rate, renal failure and antiarrhythmic agents at discharge were the independent predictors for recurrence. In total ECV was ineffective in 852 (42.6%) cases. Female gender (OR 1.44, CI95% 1.15-1.80, p < 0.01), young (<65 years) age (OR 1.31, CI95% 1.07-1.62, p = 0.01), ventricular rate >60/min (OR 1.92, CI95% 1.08-3.41, p = 0.03), antiarrhythmic medication at discharge (OR 1.48, CI95% 1.14-1.93, p < 0.01) and low (<60/ml/min) estimated glomerular filtration rate (OR 1.59, CI95% 1.08-2.33, p = 0.02) were predictors of ineffective ECV.
  
  
  
  Female gender, use of antiarrhythmic drug therapy and renal failure predicted both recurrence of AF and the composite end point. For the first time in a large real-life study several clinical predictors for clinically ineffective ECV were identified.
authors.affiliation: Department of Medicine, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland.
authors.forename: Tapio
authors.initials: T
authors.lastname: Hellman
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kiviniemi
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland.
authors.forename: Tuija
authors.initials: T
authors.lastname: Vasankari
authors.affiliation: Department of Medicine, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland.
authors.forename: Ilpo
authors.initials: I
authors.lastname: Nuotio
authors.affiliation: Department of Surgery, Oulu University Hospital, Kajaanintie 50, PO Box 10, 90029 OYS, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Heart Center, Kuopio University Hospital and University of Eastern Finland, PO Box 100, Kuopio, 70029, Finland.
authors.forename: Aissa
authors.initials: A
authors.lastname: Bah
authors.affiliation: Heart Center, Kuopio University Hospital and University of Eastern Finland, PO Box 100, Kuopio, 70029, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hartikainen
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Mäkäräinen
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland. juhani.airaksinen@tyks.fi.
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D004554:Electric Countershock; D005260:Female; D005387:Finland; D005919:Glomerular Filtration Rate; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D051437:Renal Insufficiency / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Cardioversion; Recurrence