A REVIEW OF DIRECT-CURRENT CARDIOVERSIONS FOR ATRIAL ARRHYTHMIA

The risk of arterial embolism is well recognised following Direct Curr ent Cardioversion (DCC) for atrial fibrillation although the use of pr ophylactic anticoagulation remains controversial. Aim: To determine th e risk of arterial embolism post-cardioversion and which factors predi ct successful cardioversion and maintenance of sinus rhythm. Materials and Methods: A retrospective study was carried out of all cardioversi ons performed for atrial fibrillation and atrial flutter at the Wavene y Hospital Ballymena, during 1989-1993. A review of medical records an d electrocardiograms was carried out to assess demographic characteris tics, co-existent diseases, anticoagulant status, echocardiographic fe atures and characteristics of the arrhythmia. Embolic events in the si x weeks post-cardioversion were noted. Results: The study included 157 cardioversions in 109 patients. The predominant arrhythmia was atrial fibrillation (n=108, 69%). Three of 109 patients (2.7%) experienced e mbolic complications, none of whom had anticoagulation prior to the pr ocedure. No risk factors for cerebro-vascular disease or significant v alvular heart disease were present. Return to sinus rhythm was achieve d in 143 (91%) procedures. Increasing coarseness of atrial fibrillatio n was associated with a non-significant trend towards successful resto ration of sinus rhythm (p=0.1 8). Recurrence of the original arrhythmi a was predicted by an increase in coarseness of atrial fibrillation (p <0.05). Conclusions: These findings indicate that embolic complication s can occur in patients undergoing DCC with normal echocardiographic d imensions, and that prophylactic anticoagulation should be considered in all. patients. Coarseness of atrial fibrillation may be used as a g uide to predict the chance of successful cardioversion and of the like lihood of maintaining sinus rhythm once this has been achieved.