[Therapeutic success of a prospective cardioversion protocol for persistent atrial fibrillation]. / Rendimiento terapéutico de un protocolo prospectivo de cardioversión en la fibrilación auricular persistente.

INTRODUCTION AND OBJECTIVES: The best therapeutic approach for persistent atrial fibrillation has yet to be defined. Our aim was to investigate the effects of cardioversion in unselected patients with persistent atrial fibrillation who were treated according to a strict protocol involving pretreatment, cardioversion, and follow-up. METHODS: Consecutive patients with persistent atrial fibrillation of at least 1 months' duration were included prospectively in a cardioversion protocol that involved standard antiarrhythmic pretreatment, with amiodarone being offered first, and follow-up. RESULTS: The study included 295 patients, 87.5% of whom were taking the antiarrhythmic drug amiodarone. Sinus rhythm was restored in 92.5%, with pharmacologic cardioversion occurring in 9.5%. The recurrence rate was 33.5% in the first month and 54.9% by month 12. Antiarrhythmic treatment had to be modified in 10.8% of patients. Independent risk factors for recurrence during the first year after cardioversion were an atrial fibrillation duration greater than one year, previous cardioversion, and left ventricular dilatation. A simple risk scoring system was able to differentiate between subgroups of patients with a low, intermediate or high risk of recurrence in the first year after cardioversion. CONCLUSIONS: Sinus rhythm was maintained for 1 year after effective cardioversion in 45.1% of patients who received homogeneous antiarrhythmic pretreatment. There were few side effects. Recurrence can be predicted using clinical variables such as left ventricular dilatation, arrhythmia duration, and previous cardioversion.

Rendimiento terapéutico de un protocolo prospectivo de cardioversión en la fibrilación auricular persistente / Therapeutic success of a prospective cardioversion protocol for persistent atrial fibrillation

Introducción y objetivos. La mejor estrategia de tratamiento de la fibrilación auricular persistente está por definir. Hemos querido conocer los resultados de la cardioversión en pacientes no seleccionados en los que se aplica un protocolo estricto de preparación, cardioversión y seguimiento. Métodos. Incluimos prospectivamente a pacientes consecutivos con fibrilación auricular persistente de al menos un mes de duración en un protocolo de cardioversión eléctrica con pretratamiento antiarrítmico estandarizado (amiodarona como primera opción) y seguimiento. Resultados. Se incluyó a 295 pacientes, el 87,5% de los cuales tomó amiodarona como fármaco antiarrítmico. Se consiguió restaurar el ritmo sinusal en el 92,5%; en un 9,5% de los casos la cardioversión fue farmacológica. Las recurrencias fueron del 33,5 y el 54,9% a uno y 12 meses. El tratamiento antiarrítmico se tuvo que modificar en un 10,8% de los pacientes. Los predictores independientes de recurrencia durante el primer año fueron la duración de la fibrilación auricular mayor de un año, las cardioversiones previas y la dilatación del ventrículo izquierdo. Una sencilla puntuación de riesgo permite diferenciar a los subgrupos de pacientes con bajo, intermedio y alto riesgo de recurrencia durante el primer año tras la cardioversión. Conclusiones. El mantenimiento del ritmo sinusal tras una cardioversión efectiva en pacientes con un pretratamiento antiarrítmico homogéneo es del 45,1% al año de seguimiento. Los efectos secundarios son escasos. La recurrencia puede predecirse con el uso de variables clínicas, como la dilatación ventricular izquierda, la duración de la arritmia y la historia de cardioversiones previas

Introduction and objectives. The best therapeutic approach for persistent atrial fibrillation has yet to be defined. Our aim was to investigate the effects of cardioversion in unselected patients with persistent atrial fibrillation who were treated according to a strict protocol involving pretreatment, cardioversion, and follow-up. Methods. Consecutive patients with persistent atrial fibrillation of at least 1 months' duration were included prospectively in a cardioversion protocol that involved standard antiarrhythmic pretreatment, with amiodarone being offered first, and follow-up. Results. The study included 295 patients, 87.5% of whom were taking the antiarrhythmic drug amiodarone. Sinus rhythm was restored in 92.5%, with pharmacologic cardioversion occurring in 9.5%. The recurrence rate was 33.5% in the first month and 54.9% by month 12. Antiarrhythmic treatment had to be modified in 10.8% of patients. Independent risk factors for recurrence during the first year after cardioversion were an atrial fibrillation duration greater than one year, previous cardioversion, and left ventricular dilatation. A simple risk scoring system was able to differentiate between subgroups of patients with a low, intermediate or high risk of recurrence in the first year after cardioversion. Conclusions. Sinus rhythm was maintained for 1 year after effective cardioversion in 45.1% of patients who received homogeneous antiarrhythmic pretreatment. There were few side effects. Recurrence can be predicted using clinical variables such as left ventricular dilatation, arrhythmia duration, and previous cardioversion