Clinical correlates of immediate success and outcome at 1-year follow-up of real-world cardioversion of atrial fibrillation: the Euro Heart Survey

In atrial fibrillation (AF) cardioversion is the cornerstone of the rhythm management strategy despite the lack of contemporary data on acute and long-term success. We aim to describe present-day cardioversion of AF and identify characteristics associated with immediate and long-term outcome. Based on the 5333 AF patients enrolled in the multi-centre prospective Euro Heart Survey on AF we selected the 1801 patients undergoing cardioversion at enrolment. Sinus rhythm (SR) was restored in 630 of 712 (88), 458 of 643 (71), and 333 of 446 (75) (P 0.001) of the electrical (ECV), intravenous (ivCCV), and oral (oCCV) chemical cardioversions, respectively, at the cost of few (4.2) major complications. In multivariate analysis, absence of chronic obstructive pulmonary disease (COPD) (P 0.001), presence of paroxysmal AF (PAF) (P 0.013), and use of biphasic waveform (P 0.018) were predictors of successful ECV. For ivCCV PAF (P 0.001), absence of valvular heart disease (P 0.004), and heart failure (P 0.009), the presence of hypertension (P 0.018) and coronary artery disease (P 0.007) were predictive. Success of oCCV was driven by PAF (P 0.001) and a smaller left atrial dimension (P 0.001). At 1-year follow-up 893 of 1271 (70) patients were in SR. Multivariate analysis revealed PAF (P 0.001), shorter total AF history (P 0.001), continuous use of Class Ic drugs or amiodarone during follow-up (P 0.001), absence of COPD (P 0.003), younger age (P 0.004), and smaller left atrial dimension (P 0.005) as independent predictors of SR at 1-year follow-up. Contemporary cardioversion of AF is routinely successfully and safely performed with a high proportion of patients in SR at 1-year follow-up.