Outpatient electrical cardioversion of atrial fibrillation: efficacy, safety and patients' quality of life.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia. To lower costs and to reduce hospitalization electrical cardioversion (CV) is frequently performed in an outpatient setting although data on safety and patient-acceptance are sparse. Aims of this study were to fill this gap by evaluating efficacy, complication rate, quality of life after CV and patient-acceptance of outpatient CV. METHODS: One-hundred and eleven consecutive patients with persistent AF were included. Patients were under continuous monitoring throughout the procedure and 3 h after. CV was done in deep sedation using rising energies (200->360 J). Quality of life (QoL), late adverse events and patient-acceptance were assessed 4 weeks after CV. RESULTS: AF could be terminated with a mean of 1.4 shocks in all patients. Acute adverse events could be observed in 3.6%. Late adverse events were noted in 8.2%. Seventy-four percent of the patients felt "good" or "very good" the day of CV. Eighty-nine percent of the patients would undergo a CV again and in case of a further CV 69% of the patients would prefer an outpatient setting. Patients with a lower QoL-classification had longer duration of atrial fibrillation (median 1 vs. 3 months, p<0.05). No other clinical predictor for adverse events or a low QoL-classification could be identified. CONCLUSION: Electrical CV of persistent AF in an outpatient setting is feasible, safe and has a high patient-acceptance.

Incidence and management of early recurrent atrial fibrillation (ERAF) after transthoracic electrical cardioversion.

AIMS: The purpose was to determine the incidence of early recurrent atrial fibrillation (ERAF) after transthoracic cardioversion (CV) of persistent atrial fibrillation (AF) and to evaluate the efficacy of a predefined strategy for its management. METHODS AND RESULTS: Consecutive patients (n=135) underwent elective CV of AF. CV was performed according to a predefined step-up protocol with rising energy delivery (200 J to 360 J). ERAF was defined as a relapse of AF within 1 min after at least two sinus beats. For proper identification of success of CV, additional endocardial recordings were obtained by an electrode catheter positioned in the high right atrium. In case of ERAF, further CVs were attempted, first with higher energy delivery only, second after intravenous flecainide. If transthoracic CV was ineffective, an internal CV was scheduled. All patients could be converted into sinus rhythm. Sixteen patients (12%) had ERAF. ERAF could be suppressed by further shock delivery in 31% of them. In the remaining 69%, a combination of i.v. flecainide and repeated CV was effective in controlling ERAF. Clinical and echocardiographic parameters were comparable in patients with or without ERAF. CONCLUSION: (1) In the patient population studied, transthoracic CV of AF was technically highly efficacious, so that an internal CV was not necessary in any of the cases. (2) Clinical success of transthoracic cardioversion was limited by ERAF in 12% of the patients. (3) Using the described protocol, ERAF could be suppressed in all patients.