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Outcomes After Nonemergent Electrical Cardioversion for Atrial Arrhythmias
Electrical cardioversion (ECV) is recommended for rhythm control in patients with atrial arrhythmia; yet, ECV use and outcomes in contemporary practice are unknown. We reviewed all nonemergent ECVs for atrial arrhythmias at a tertiary care center (2010 to 2013), stratifying patients by transesophage...
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| Published in: | The American journal of cardiology 2015-05, Vol.115 (10), p.1407-1414 |
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| creator | Steinberg, Benjamin Adam, MD, MHS Schulte, Phillip Joel, PhD Hofmann, Paul, BS Ersbøll, Mads, MD Alexander, John Hunter, MD, MHS Broderick-Forsgren, Kathleen, MD Anstrom, Kevin Joseph, PhD Granger, Christopher Bull, MD Piccini, Jonathan Paul, MD, MHS Velazquez, Eric Jose, MD Shah, Bimal Ramesh, MD, MBA |
| description | Electrical cardioversion (ECV) is recommended for rhythm control in patients with atrial arrhythmia; yet, ECV use and outcomes in contemporary practice are unknown. We reviewed all nonemergent ECVs for atrial arrhythmias at a tertiary care center (2010 to 2013), stratifying patients by transesophageal echocardiography (TEE) use before ECV and comparing demographics, history, vitals, and laboratory studies. Outcomes included postprocedural success and complications and repeat cardioversion, rehospitalization, and death within 30 days. Overall, 1,017 patients underwent ECV, 760 (75%) for atrial fibrillation and 240 (24%) for atrial flutter; 633 underwent TEE before ECV and 384 did not. TEE recipients were more likely to be inpatients (74% vs 44%, p |
| doi_str_mv | 10.1016/j.amjcard.2015.02.030 |
| format | article |
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We reviewed all nonemergent ECVs for atrial arrhythmias at a tertiary care center (2010 to 2013), stratifying patients by transesophageal echocardiography (TEE) use before ECV and comparing demographics, history, vitals, and laboratory studies. Outcomes included postprocedural success and complications and repeat cardioversion, rehospitalization, and death within 30 days. Overall, 1,017 patients underwent ECV, 760 (75%) for atrial fibrillation and 240 (24%) for atrial flutter; 633 underwent TEE before ECV and 384 did not. TEE recipients were more likely to be inpatients (74% vs 44%, p <0.001), have higher mean CHADS2 scores (2.6 vs 2.4, p = 0.03), and lower mean international normalized ratios (1.2 vs 2.1, p <0.001). Overall, 89 patients (8.8%) did not achieve sinus rhythm and 14 experienced procedural complications (1.4%). Within 30 days, 80 patients (7.9%) underwent repeat ECV, 113 (11%) were rehospitalized, and 14 (1.4%) died. Although ECV success was more common in patients who underwent TEE before ECV (77% vs 68%, p = 0.01), there were no differences in 30-day death or rehospitalization rates (11.1% vs 13.0%, p = 0.37). In multivariate analyses, higher pre-ECV heart rate was associated with increased rehospitalization or death (adjusted hazard ratio 1.15/10 beats/min, 95% confidence interval 1.07 to 1.24, p <0.001), whereas TEE use was associated with lower rates (adjusted hazard ratio 0.58, 95% confidence interval 0.39 to 0.86, p = 0.007). In conclusion, failures, complications, and rehospitalization after nonemergent ECV are common and associated more with patient condition than procedural characteristics. TEE use was associated with better clinical outcomes.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2015.02.030</identifier><identifier>PMID: 25784514</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age ; Aged ; Atrial Fibrillation - diagnostic imaging ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - therapy ; Blood pressure ; Cardiac arrhythmia ; Cardiovascular ; Cardiovascular disease ; Clinical outcomes ; Confidence intervals ; Diabetes ; Echocardiography, Transesophageal ; Electric Countershock - methods ; Emergencies ; Family medical history ; Female ; Follow-Up Studies ; Heart failure ; Heart rate ; Heart Rate - physiology ; Hospitalization ; Humans ; Hypertension ; Hypoxia ; Kidney diseases ; Laboratories ; Male ; Middle Aged ; Retrospective Studies ; Sinuses ; Stroke ; Studies ; Treatment Outcome ; Variables</subject><ispartof>The American journal of cardiology, 2015-05, Vol.115 (10), p.1407-1414</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited May 15, 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c565t-e9973ead094e041dc2fa122cf7681d9f58a105b9653f59b4ad14edc2cb147a7e3</citedby><cites>FETCH-LOGICAL-c565t-e9973ead094e041dc2fa122cf7681d9f58a105b9653f59b4ad14edc2cb147a7e3</cites><orcidid>0000-0002-4729-7820</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25784514$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Steinberg, Benjamin Adam, MD, MHS</creatorcontrib><creatorcontrib>Schulte, Phillip Joel, PhD</creatorcontrib><creatorcontrib>Hofmann, Paul, BS</creatorcontrib><creatorcontrib>Ersbøll, Mads, MD</creatorcontrib><creatorcontrib>Alexander, John Hunter, MD, MHS</creatorcontrib><creatorcontrib>Broderick-Forsgren, Kathleen, MD</creatorcontrib><creatorcontrib>Anstrom, Kevin Joseph, PhD</creatorcontrib><creatorcontrib>Granger, Christopher Bull, MD</creatorcontrib><creatorcontrib>Piccini, Jonathan Paul, MD, MHS</creatorcontrib><creatorcontrib>Velazquez, Eric Jose, MD</creatorcontrib><creatorcontrib>Shah, Bimal Ramesh, MD, MBA</creatorcontrib><title>Outcomes After Nonemergent Electrical Cardioversion for Atrial Arrhythmias</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Electrical cardioversion (ECV) is recommended for rhythm control in patients with atrial arrhythmia; yet, ECV use and outcomes in contemporary practice are unknown. We reviewed all nonemergent ECVs for atrial arrhythmias at a tertiary care center (2010 to 2013), stratifying patients by transesophageal echocardiography (TEE) use before ECV and comparing demographics, history, vitals, and laboratory studies. Outcomes included postprocedural success and complications and repeat cardioversion, rehospitalization, and death within 30 days. Overall, 1,017 patients underwent ECV, 760 (75%) for atrial fibrillation and 240 (24%) for atrial flutter; 633 underwent TEE before ECV and 384 did not. TEE recipients were more likely to be inpatients (74% vs 44%, p <0.001), have higher mean CHADS2 scores (2.6 vs 2.4, p = 0.03), and lower mean international normalized ratios (1.2 vs 2.1, p <0.001). Overall, 89 patients (8.8%) did not achieve sinus rhythm and 14 experienced procedural complications (1.4%). Within 30 days, 80 patients (7.9%) underwent repeat ECV, 113 (11%) were rehospitalized, and 14 (1.4%) died. Although ECV success was more common in patients who underwent TEE before ECV (77% vs 68%, p = 0.01), there were no differences in 30-day death or rehospitalization rates (11.1% vs 13.0%, p = 0.37). In multivariate analyses, higher pre-ECV heart rate was associated with increased rehospitalization or death (adjusted hazard ratio 1.15/10 beats/min, 95% confidence interval 1.07 to 1.24, p <0.001), whereas TEE use was associated with lower rates (adjusted hazard ratio 0.58, 95% confidence interval 0.39 to 0.86, p = 0.007). In conclusion, failures, complications, and rehospitalization after nonemergent ECV are common and associated more with patient condition than procedural characteristics. TEE use was associated with better clinical outcomes.</description><subject>Age</subject><subject>Aged</subject><subject>Atrial Fibrillation - diagnostic imaging</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - therapy</subject><subject>Blood pressure</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Clinical outcomes</subject><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>Echocardiography, Transesophageal</subject><subject>Electric Countershock - methods</subject><subject>Emergencies</subject><subject>Family medical history</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart failure</subject><subject>Heart rate</subject><subject>Heart Rate - physiology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypoxia</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Sinuses</subject><subject>Stroke</subject><subject>Studies</subject><subject>Treatment Outcome</subject><subject>Variables</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkcFu1DAQhi0EosvCI4Aiceklqcex4_hStFoVaFXRA3C2vM6EOk3iYieV9u1xtEsr9dKTZc03M_b3E_IRaAEUqrOuMENnTWgKRkEUlBW0pK_ICmqpclBQviYrSinLFXB1Qt7F2KUrgKjekhMmZM0F8BW5upkn6weM2aadMGQ__IgDhj84TtlFj3YKzpo-26ZFzj9giM6PWetDtkmVVNiEcLufbgdn4nvypjV9xA_Hc01-f734tf2eX998u9xurnMrKjHlqJQs0TRUcaQcGstaA4zZVlY1NKoVtQEqdqoSZSvUjpsGOCbK7oBLI7Fck9PD3Pvg_84YJz24aLHvzYh-jhoqKUupykol9PMztPNzGNPrElWD4LJOa9ZEHCgbfIwBW30f3GDCXgPVi2zd6aNsvcjWlOkkO_V9Ok6fdwM2j13_7SbgywHApOPBYdDROhwtNi4ktbrx7sUV588m2N6NSyR3uMf49BsdU4P-uSS-BA6CUskqVv4Du-CnEA</recordid><startdate>20150515</startdate><enddate>20150515</enddate><creator>Steinberg, Benjamin Adam, MD, MHS</creator><creator>Schulte, Phillip Joel, PhD</creator><creator>Hofmann, Paul, BS</creator><creator>Ersbøll, Mads, MD</creator><creator>Alexander, John Hunter, MD, MHS</creator><creator>Broderick-Forsgren, Kathleen, MD</creator><creator>Anstrom, Kevin Joseph, PhD</creator><creator>Granger, Christopher Bull, MD</creator><creator>Piccini, Jonathan Paul, MD, MHS</creator><creator>Velazquez, Eric Jose, MD</creator><creator>Shah, Bimal Ramesh, MD, MBA</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4729-7820</orcidid></search><sort><creationdate>20150515</creationdate><title>Outcomes After Nonemergent Electrical Cardioversion for Atrial Arrhythmias</title><author>Steinberg, Benjamin Adam, MD, MHS ; Schulte, Phillip Joel, PhD ; Hofmann, Paul, BS ; Ersbøll, Mads, MD ; Alexander, John Hunter, MD, MHS ; Broderick-Forsgren, Kathleen, MD ; Anstrom, Kevin Joseph, PhD ; Granger, Christopher Bull, MD ; Piccini, Jonathan Paul, MD, MHS ; Velazquez, Eric Jose, MD ; Shah, Bimal Ramesh, MD, MBA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c565t-e9973ead094e041dc2fa122cf7681d9f58a105b9653f59b4ad14edc2cb147a7e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Age</topic><topic>Aged</topic><topic>Atrial Fibrillation - 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Steinberg, Benjamin Adam, MD, MHS</au><au>Schulte, Phillip Joel, PhD</au><au>Hofmann, Paul, BS</au><au>Ersbøll, Mads, MD</au><au>Alexander, John Hunter, MD, MHS</au><au>Broderick-Forsgren, Kathleen, MD</au><au>Anstrom, Kevin Joseph, PhD</au><au>Granger, Christopher Bull, MD</au><au>Piccini, Jonathan Paul, MD, MHS</au><au>Velazquez, Eric Jose, MD</au><au>Shah, Bimal Ramesh, MD, MBA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes After Nonemergent Electrical Cardioversion for Atrial Arrhythmias</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2015-05-15</date><risdate>2015</risdate><volume>115</volume><issue>10</issue><spage>1407</spage><epage>1414</epage><pages>1407-1414</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Electrical cardioversion (ECV) is recommended for rhythm control in patients with atrial arrhythmia; yet, ECV use and outcomes in contemporary practice are unknown. We reviewed all nonemergent ECVs for atrial arrhythmias at a tertiary care center (2010 to 2013), stratifying patients by transesophageal echocardiography (TEE) use before ECV and comparing demographics, history, vitals, and laboratory studies. Outcomes included postprocedural success and complications and repeat cardioversion, rehospitalization, and death within 30 days. Overall, 1,017 patients underwent ECV, 760 (75%) for atrial fibrillation and 240 (24%) for atrial flutter; 633 underwent TEE before ECV and 384 did not. TEE recipients were more likely to be inpatients (74% vs 44%, p <0.001), have higher mean CHADS2 scores (2.6 vs 2.4, p = 0.03), and lower mean international normalized ratios (1.2 vs 2.1, p <0.001). Overall, 89 patients (8.8%) did not achieve sinus rhythm and 14 experienced procedural complications (1.4%). Within 30 days, 80 patients (7.9%) underwent repeat ECV, 113 (11%) were rehospitalized, and 14 (1.4%) died. Although ECV success was more common in patients who underwent TEE before ECV (77% vs 68%, p = 0.01), there were no differences in 30-day death or rehospitalization rates (11.1% vs 13.0%, p = 0.37). In multivariate analyses, higher pre-ECV heart rate was associated with increased rehospitalization or death (adjusted hazard ratio 1.15/10 beats/min, 95% confidence interval 1.07 to 1.24, p <0.001), whereas TEE use was associated with lower rates (adjusted hazard ratio 0.58, 95% confidence interval 0.39 to 0.86, p = 0.007). In conclusion, failures, complications, and rehospitalization after nonemergent ECV are common and associated more with patient condition than procedural characteristics. TEE use was associated with better clinical outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25784514</pmid><doi>10.1016/j.amjcard.2015.02.030</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4729-7820</orcidid><oa>free_for_read</oa></addata></record> |
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| source | ScienceDirect Journals |
| subjects | Age Aged Atrial Fibrillation - diagnostic imaging Atrial Fibrillation - physiopathology Atrial Fibrillation - therapy Blood pressure Cardiac arrhythmia Cardiovascular Cardiovascular disease Clinical outcomes Confidence intervals Diabetes Echocardiography, Transesophageal Electric Countershock - methods Emergencies Family medical history Female Follow-Up Studies Heart failure Heart rate Heart Rate - physiology Hospitalization Humans Hypertension Hypoxia Kidney diseases Laboratories Male Middle Aged Retrospective Studies Sinuses Stroke Studies Treatment Outcome Variables |
| title | Outcomes After Nonemergent Electrical Cardioversion for Atrial Arrhythmias |
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