title: Cardioversion and subsequent quality of life and natural history of atrial fibrillation.
abstract: Cardioversion is a class I procedure for patients with symptomatic atrial fibrillation (AF) pursuing rhythm control. There are few contemporary reports on quality of life and outcomes after cardioversion.
  
  
  METHODS
  Using the nationwide prospective ORBIT-AF registry, cardioversion patients were propensity matched 3:1 to noncardioverted patients and Cox proportional hazards modeling evaluated hospitalization at 1 year in those with and without cardioversion. Cardiovascular outcomes, AF progression, and quality of life were evaluated for the matched cohorts with and without cardioversion.
  
  
  RESULTS
  Among 9,642 patients, 817 patients (8%) underwent 906 cardioversions during a median follow-up of 12 (interquartile range 6-18) months. Among matched cardioverted and noncardioverted patients, 1-year cardiovascular hospitalization rates were 43% vs 21% (adjusted hazard ratio 2.2, 95% CI 1.8-2.8, P<.001), and sinus rhythm at both first and second follow-ups was 36% vs 27% (P=.042), respectively. Findings were similar among first-time cardioversion patients. Matched cardioversion patients did not exhibit greater symptom improvement (34% vs 42%) or less symptomatic progression (15% vs 4%) by European Heart Rhythm Association scores. Cardioversion was associated with AF progression with an odds ratio of 1.6 (95% CI 1.2-2.2, P=.001) after cardioversion and 2.7 (P<.001) after first cardioversion vs matched noncardioversion patients. After cardioversion, only 18% of patients not previously on an antiarrhythmic started one, less than 5% underwent ablation, and 22% stopped their antiarrhythmic.
  
  
  CONCLUSIONS
  Cardioversion was not associated with improved AF-related quality of life or less progression. Many patients who undergo cardioversion do not receive adjunctive rhythm control therapies. These findings may help to better inform therapeutic decision making.
authors.affiliation: Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: sean.pokorney@duke.edu.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Pokorney
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: sunghee.kim@dm.duke.edu.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: laine.thomas@dm.duke.edu.
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: UCLA Division of Cardiology, Los Angeles, CA. Electronic address: GFonarow@mednet.ucla.edu.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Lankenau Institute for Medical Research, Wynnewood, PA. Electronic address: koweyp@mlhs.org.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN. Electronic address: Gersh.Bernard@mayo.edu.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Electronic address: kenneth.mahaffey@stanford.edu.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: eric.peterson@dm.duke.edu.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: jonathan.piccini@dm.duke.edu.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D016022:Case-Control Studies; D017115:Catheter Ablation; D018450:Disease Progression; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents