Introduction: The medium-term maintenance of sinus rhythm (SR) following elective cardioversion (DCCV) for persistent atrial fibrillation (AF) is low. At our centre, AF recurrence within 6 months was 50% in a retrospective database of over 500 patients. As part of the nurse-led cardioversion service at a district general hospital we looked at the effect of targeted amiodarone pre-treatment for patients referred for DCCV with left ventricular systolic dysfunction (LVSD), or left atrial (LA) dilatation, or previous failed cardioversion.
Methods: A retrospective analysis of DCCV cases across an 18-month period recording was studied. Demographics, echocardiographic findings and rhythm outcomes up to 6 months were recorded. We focussed on outcomes in LVSD, LA dilation and body mass index >30 kg/m2. LVSD was classified as moderate (EF 35–45%) or severe (EF <35%), LA dilation was recorded if either moderate or severe (LA diameter >4.7 cm). Amiodarone use was at the referring consultants’ discretion and reflected varying practice between cardiologists.
Outcomes at DCCV and AF recurrence within 6 months were recorded (where available). All patients had serial thyroid, liver and renal function monitoring. All were counselled of relevant side effects of amiodarone and followed up. Statistical analysis with Fischer’s exact T-test compared outcomes of patients treated with amiodarone against those not.
Results: 189 cardioversions for persistent AF were analysed, with 39 of these long-standing persistent (> 1-year duration). Median age was 67 (IQR 58–73) and mean CHA2DS2-VASc was 2.1.
Outcomes of DCCV with and without Amiodarone treatment are compared in Table 1.