Changes in oral anticoagulation for elective cardioversion: results from a European cardioversion registry.
In patients with atrial fibrillation (AF) pharmacological or electrical cardioversion may be performed to restore sinus rhythm. The procedure is associated with an increased risk of thromboembolic events, which can be significantly reduced by adequate anticoagulation (OAC). Our aim was to create a partly prospective, partly retrospective cardioversion registry, particularly focusing on OAC strategies in different European countries, and on emerging choice of OAC over time.



From September 2014 to October 2015, cardioversions due to AF performed in six European city hospitals in five European countries (Hungary: Budapest-1 and -2; Italy: Bari and Pisa; France: Amiens; Spain: Madrid; and Lithuania: Kaunas) were recorded in the registry.



A total of 1101 patients (retrospective/prospective: 679/422, male/female: 742/359, mean age: 67.3 years ± 11.2) were registered. Most of the cardioversions were electrical (97%). Oral anticoagulants were administered in 87% of the patient, the usage of non-VKA oral anticoagulants (NOACs) vs Vitamin K antagonists (VKA) was 31.5% vs 68.5%, respectively. Seventy seven percent of the patients were given oral anticoagulants more than 3 weeks prior to the procedure, and 86% more than 4 weeks after the procedure. When using VKA, international normalized ratio (INR) at cardioversion was above 2.0 in 76% of the cases. A decline in VKA usage (P = 0.033) in elective cardioversion over approximately 1 year was observed. During the observation period, there was an increase in apixaban (P < 0.001), a slight increase in rivaroxaban (P = 0.028) and no changes in dabigatran (P = 0.34) usage for elective cardioversion. There were differences in use of OAC between the countries: Spain used most VKA (89%), while France used least VKA (39%, P < 0.001).



According to current AF guidelines, NOACs are adequate alternatives to VKA for thromboembolic prevention in AF patients undergoing elective cardioversion. Our results indicate that NOAC use is increasing and there is a significant decrease in VKA use.
Department of Cardiology, Medical Center Hungarian Defence Forces, 44 Robert Karoly Krt., 1134 Budapest, Hungary.
Judit
J
Papp
Heart and Vascular Center, Semmelweis University, 68 Varosmajor u., 1122 Budapest, Hungary.
Endre
E
Zima
Cardiology Department, University Hospital Clinico San Carlos, Profesor Martin Lagos s/n, 28040 Madrid, Spain.
Ramon
R
Bover
Lithuanian University of Health Sciences, Cardiology Clinic, 2 Eiveniu str., 50161 Kaunas, Lithuania.
Rasa
R
Karaliute
Cardiothoracic Department, Tuscany Foundation Gabriele Monasterio, 1 Via G. Moruzzi, 56124 Pisa, Italy.
Andrea
A
Rossi
Cardiology Department, Amiens University Hospital, Avenue Rene Laennec, 80000 Salouel Amiens, France.
Catherine
C
Szymanski
Cardiologia Ospedaliera Polyclinic of Bari, 11 Piazza Giulio Cesare, 70124 Bari, Italy.
Rossella
R
Troccoli
Bayer Healthcare, 178 Müllerstrasse, 13353 Berlin, Germany.
Jonas
J
Schneider
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
Morten Wang
MW
Fagerland
Molecular and Clinical Research Institute and Cardiology Clinical Academic Group, St. George's University of London and Imperial College, London SW17 0RE, UK.
A John
AJ
Camm
Cardiology Department B and Faculty of Medicine, Oslo University Hospital, University of Oslo, 166 Kirkeveien, Building 3-A, 0407 Oslo, Norway.
Dan
D
Atar
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
D000925:Anticoagulants
Anticoagulation; Atrial fibrillation; Cardioversion; NOACs; Registry