Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice

BMC Cardiovascular Disorders

Xavier Sabaté⁴  Jordi Pérez-Rodon¹  Naiara Calvo²  Roger Villuendas³  Silvia Pons⁵  César Romero-Menor⁷  Xavier Viñolas⁸  Josep M Alegret⁶ 

[1] Hospital Vall d’Hebron, Barcelona, Spain;Hospital Clínic, Barcelona, Spain;Hospital Germans Trias i Pujol, Badalona, Spain;Hospital de Bellvitge, Hospitalet de Llobregat, Spain;Hospital de Barcelona, Barcelona, Spain;Secció de Cardiologia, Hospital Universitari de Sant Joan, Institut d’Investigacions Sanitàries Pere Virgili, Universitat Rovira i Virgili, C/Dr. Laporte, s/n, Reus, 43205, Spain;Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain;Hospital de la Sta. Creu i Sant Pau, Barcelona, Spain

关键词: Follow-up;    Rate control;    Rhythm control;    Electrical cardioversion;    Atrial fibrillation;   

Others  :  1084911
DOI  :  10.1186/1471-2261-12-42

 received in 2012-02-14, accepted in 2012-05-31,  发布年份 2012

【 摘 要 】

Background

The purpose of the present study was to assess the trends in the use of ECV following published studies that had compared rhythm and rate control strategies on atrial fibrillation (AF), and the recommendations included in the current clinical practice guidelines.

Methods

The REVERCAT is a population-based assessment of the use of electrical cardioversion (ECV) in treating persistent AF in Catalonia (Spain). The initial survey was conducted in 2003 and the follow-up in 2010.

Results

We observed a decrease of 9% in the absolute numbers of ECV performed (436 in 2003 vs. 397 in 2010). This is equivalent to 27% when considering population increases over this period. The patients treated with ECV in 2010 were younger, had a lower prevalence of previous embolism, a higher prevalence of diabetes, and increased body weight. Underlying heart disease factors indicated, in 2010, a higher proportion of NYHA ≥ II and left ventricular ejection fraction <30%. We observed a reduction in the number of ECV performed in 16 of the 27 (67%) participating hospitals. However, there was an increase of 14% in the number of procedures performed in tertiary hospitals, and was related to the increasing use of ECV as a bridge to AF ablation. Considering the initial number of patients treated with ECV, the rate of sinus rhythm at 3 months was almost unchanged (58% in 2003 vs. 57% in 2010; p = 0.9) despite the greater use of biphasic energy in 2010 and a similar prescription of anti-arrhythmic drugs.

Conclusions

Although we observed a decrease in the number of ECVs performed over the 7 year period between the two studies, this technique remains a common option for treating patients with persistent AF. The change in the characteristics of candidate patients did not translate into better outcomes.

【 授权许可】

   
2012 Alegret et al.; licensee BioMed Central Ltd.

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