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Cardiovascular Events of Electrical Cardioversion Under Optimal Anticoagulation in Atrial Fibrillation: The Multicenter Analysis

Authors
 Dong Geum Shin  ;  Iksung Cho  ;  Bríain ó Hartaigh  ;  Hee-Sun Mun  ;  Hye-Young Lee  ;  Eui Seock Hwang  ;  Jin-Kyu Park  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
Citation
 Yonsei Medical Journal, Vol.56(6) : 1552-1558, 2015 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2015
Abstract
PURPOSE: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale study about the acute cardiovascular events following electrical cardioversion of AF is lacking. This study was performed to evaluate the incidence, risk factors, and clinical consequences of acute cardiovascular events following electrical cardioversion of AF. MATERIALS AND METHODS: The study enrolled 1100 AF patients (mean age 60±11 years) who received cardioversion at four tertiary hospitals. Hospitalizations for stroke/transient ischemic attack, major bleedings, and arrhythmic events during 30 days post electric cardioversion were assessed. RESULTS: The mean duration of anticoagulation before cardioversion was 95.8±51.6 days. The mean International Normalized Ratio at the time of cardioversion was 2.4±0.9. The antiarrhythmic drugs at the time of cardioversion were class I (45%), amiodarone (40%), beta-blocker (53%), calcium-channel blocker (21%), and other medication (11%). The success rate of terminating AF via cardioversion was 87% (n=947). Following cardioversion, 5 strokes and 5 major bleedings occurred. The history of stroke/transient ischemic attack (OR 6.23, 95% CI 1.69-22.90) and heart failure (OR 6.40, 95% CI 1.77-23.14) were among predictors of thromboembolic or bleeding events. Eight patients were hospitalized for bradyarrhythmia. These patients were more likely to have had a lower heart rate prior to the procedure (p=0.045). Consequently, 3 of these patients were implanted with a permanent pacemaker. CONCLUSION: Cardioversion appears as a safe procedure with a reasonably acceptable cardiovascular event rate. However, to prevent the cardiovascular events, several risk factors should be considered before cardioversion.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/141728
DOI
10.3349/ymj.2015.56.6.1552
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
박진규(Park, Jin Kyu) ; 박희남(Pak, Hui Nam) ; 신동금(Shin, Dong Geum) ; 엄재선(Uhm, Jae Sun) ; 이문형(Lee, Moon Hyoung) ; 정보영(Joung, Bo Young) ; 조익성(Cho, Ik Sung)
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