Electrical cardioversion of persistent atrial fibrillation: acute and long-term results stratified according to arrhythmia duration

Pacing Clin Electrophysiol. 2012 Sep;35(9):1126-34. doi: 10.1111/j.1540-8159.2012.03453.x. Epub 2012 Jul 3.


Background: Current definition of persistent atrial fibrillation (PAF) enrolls a heterogeneous population with different atrial fibrillation (AF) exposure and degree of atrial substrate. Study aims were to evaluate acute and long-term results of electrical cardioversion (ECV) and to identify temporal cutoff of previous AF exposure to reclassify PAF in subgroups with different chance of sinus rhythm (SR) maintenance.

Methods: Five hundred twenty-one patients (66% men; age 69 ± 10 years) with PAF undergoing ECV, were divided in four groups according to AF duration at the time of ECV: group A with AF ≤2 months (141 patients); group B with AF >2 and ≤4 months (176 patients); group C with AF >4 and ≤6 months (89 patients); and group D with AF >6 months and <1 year (115 patients).

Results: There was no difference in term of acute success among groups (98.5% vs 97.1% vs 98.9% vs 96.5%, respectively, P = 0.95). At 5-year follow-up, 198 (41%) patients were in SR: 50% in group A, 44% in group B, 42% in group C, and 25% in group D (P < 0.001). At the multivariate analysis, previous ECV (hazard ratio [HR] 1.55, P < 0.001), left atrium enlargement (HR 1.39, P = 0.013), and AF duration >6 months at time of procedure (HR 1.59, P = 0.001) independently predict ECV failure.

Conclusion: ECV is associated with high acute success rate and low complications rate. Long-term results are strongly related with AF duration at time of ECV: a cutoff of >6 months helps in selecting patients that can take greater advantage of the procedure.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Acute Disease
  • Aged
  • Atrial Fibrillation / mortality*
  • Atrial Fibrillation / prevention & control*
  • Chronic Disease
  • Disease-Free Survival
  • Electric Countershock / mortality*
  • Female
  • Humans
  • Italy / epidemiology
  • Male
  • Prevalence
  • Survival
  • Survival Analysis
  • Treatment Outcome