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

Aims 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. Methods and results 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. Conclusions Contemporary cardioversion of AF is routinely successfully and safely performed with a high proportion of patients in SR at 1-year follow-up.