Electrical cardioversion of atrial fibrillation and the risk of brady-arrhythmic events
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Electrical cardioversion of atrial fibrillation and the risk of brady-arrhythmic events. / Rasmussen, Peter Vibe; Blanche, Paul; Dalgaard, Frederik; Gislason, Gunnar Hilmar; Torp-Pedersen, Christian; Tønnesen, Jacob; Ruwald, Martin H.; Pallisgaard, Jannik Langtved; Hansen, Morten Lock.
In: American Heart Journal, Vol. 244, 2022, p. 42-49.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Electrical cardioversion of atrial fibrillation and the risk of brady-arrhythmic events
AU - Rasmussen, Peter Vibe
AU - Blanche, Paul
AU - Dalgaard, Frederik
AU - Gislason, Gunnar Hilmar
AU - Torp-Pedersen, Christian
AU - Tønnesen, Jacob
AU - Ruwald, Martin H.
AU - Pallisgaard, Jannik Langtved
AU - Hansen, Morten Lock
N1 - Publisher Copyright: © 2021
PY - 2022
Y1 - 2022
N2 - Background: Electrical cardioversion (ECV) is a common procedure for terminating atrial fibrillation (AF). ECV is associated with brady-arrhythmic events, however, the age-specific risks of clinically significant brady-arrhythmic events are unknown. Methods: Using Danish nationwide registers, we identified patients with AF at their first non-emergent ECV between 2005 and 2018 and estimated their 30-day risk of brady-arrhythmic events. Moreover, factors associated with increased risks of brady-arrhythmias were identified. Absolute risks were estimated using logistic regression models fitted with natural splines as well as standardization (G-formula). Results: We identified 20,725 eligible patients with a median age of 66 years (IQR 60-72) and most males (73%). The 30-day risks of brady-arrhythmic events after ECV were highly dependent on age with estimated risks ranging from 0.5% (95% CI 0.2-1.7) and 1.2% (95% CI 0.99-1.5) to 2.7% (95% CI 2.1-3.3) and 5.1% (95% CI 2.6-9.7) in patients aged 40, 65, 80, and 90 years, respectively. Factors associated with brady-arrhythmias were generally related to cardiovascular disease (eg, ischemic heart disease, heart failure, valvular AF) or a history of syncope. We found no indications that pre-treatment with anti-arrhythmic drugs conferred increased risks of brady-arrhythmic events (standardized absolute risk difference -0.25% [95% CI -0.67 to 0.17]). Conclusions: ECV conferred clinically relevant 30-day risks of brady-arrhythmic events, especially in older patients. Anti-arrhythmic drug treatment was not found to increase the risk of brady-arrhythmias. Given the widespread use of ECV, these data should provide insights regarding the potential risks of brady-arrhythmic events.
AB - Background: Electrical cardioversion (ECV) is a common procedure for terminating atrial fibrillation (AF). ECV is associated with brady-arrhythmic events, however, the age-specific risks of clinically significant brady-arrhythmic events are unknown. Methods: Using Danish nationwide registers, we identified patients with AF at their first non-emergent ECV between 2005 and 2018 and estimated their 30-day risk of brady-arrhythmic events. Moreover, factors associated with increased risks of brady-arrhythmias were identified. Absolute risks were estimated using logistic regression models fitted with natural splines as well as standardization (G-formula). Results: We identified 20,725 eligible patients with a median age of 66 years (IQR 60-72) and most males (73%). The 30-day risks of brady-arrhythmic events after ECV were highly dependent on age with estimated risks ranging from 0.5% (95% CI 0.2-1.7) and 1.2% (95% CI 0.99-1.5) to 2.7% (95% CI 2.1-3.3) and 5.1% (95% CI 2.6-9.7) in patients aged 40, 65, 80, and 90 years, respectively. Factors associated with brady-arrhythmias were generally related to cardiovascular disease (eg, ischemic heart disease, heart failure, valvular AF) or a history of syncope. We found no indications that pre-treatment with anti-arrhythmic drugs conferred increased risks of brady-arrhythmic events (standardized absolute risk difference -0.25% [95% CI -0.67 to 0.17]). Conclusions: ECV conferred clinically relevant 30-day risks of brady-arrhythmic events, especially in older patients. Anti-arrhythmic drug treatment was not found to increase the risk of brady-arrhythmias. Given the widespread use of ECV, these data should provide insights regarding the potential risks of brady-arrhythmic events.
U2 - 10.1016/j.ahj.2021.10.182
DO - 10.1016/j.ahj.2021.10.182
M3 - Journal article
C2 - 34666012
AN - SCOPUS:85119382404
VL - 244
SP - 42
EP - 49
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -
ID: 286504829