RESUMO
BACKGROUND: To investigate which factors influence the immediate and long-term outcome of elective electrical cardioversion for persistent (>48h) atrial fibrillation or flutter. METHODS: In 255 patients, 435 electrical cardioversions were performed. Relevant clinical, electrocardiographic and echocardiographic factors were registered at each cardioversion. Each factor was tested separately in relation to immediate success and the outcome at six months and one year after cardioversion. RESULTS: In 70% of the patients, sinus rhythm was restored immediately after electrical cardioversion. After six months only 20% of the patients were still in sinus rhythm, and one year after cardioversion this figure had dropped to 14%. Sotalol used during electrical cardioversion resulted in the highest immediate success. Furthermore, atrial flutter, two or fewer electrical shocks and shocks ≤200 Joules resulted in the highest immediate success rate, whilst hypertensive heart disease resulted in the lowest immediate success rate. However, only shocks ≤200 Joules and a first cardioversion promoted the persistence of sinus rhythm after six months. A normal electrocardiogram, two or more cardioversions in the past and the use of a beta-blocking drug other than sotalol during cardioversion increased the chance of recurrence within six months. The duration of the arrhythmia >one month to
RESUMO
On administering thrombolysis in a prehospital setting, we found a threefold increase in the incidence of abortion of myocardial infarction, compared with the in-hospital program of a nearby hospital. Assessment of aborted myocardial infarction may be a better criterion for the efficacy of early thrombolysis than mortality data.