Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly

Ahmad A. Elesber, Ana Gabriela Rosales, Regina M. Herges, Win Kuang Shen, Brenda S. Moon, Joseph F. Malouf, Naser M. Ammash, Virend Somers, David O. Hodge, Bernard J. Gersh, Stephen C. Hammill, Paul A. Friedman

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Aims: Trials of rate control vs. rhythm control for atrial fibrillation or flutter included few patients with new-onset arrhythmia. Our objective was to assess the relapse rate and the effect of the relapse of new-onset atrial arrhythmias on mortality after direct-current cardioversion (DCCV). Methods and results: A cohort of 351 patients with atrial fibrillation (new onset in 179) and 126 patients with atrial flutter (new onset in 78) was followed-up after DCCV. Cox proportional hazard models were used. Median age was 74.6 years. Mean follow-up for relapse was 7.7 months; for death, 29.4 months. Patients with new-onset atrial flutter [adjusted hazard ratio (HR) = 1] were more likely to maintain sinus rhythm than the patients with recurrent atrial flutter (adjusted HR = 2.5, P < 0.01), new-onset atrial fibrillation (adjusted HR = 2.4, P < 0.01), or recurrent atrial fibrillation (adjusted HR = 2.7, P < 0.01). Patients with new-onset atrial fibrillation were as likely to have relapses as patients with recurrent atrial fibrillation or flutter. Relapse of atrial arrhythmia after DCCV was associated with increased mortality (adjusted HR = 3.1, P < 0.01). Conclusion: DCCV is more successful in maintaining sinus rhythm in patients with new-onset atrial flutter than in patients with new-onset atrial fibrillation. Relapse of atrial arrhythmia after cardioversion is associated with increased mortality.

Original languageEnglish (US)
Pages (from-to)854-860
Number of pages7
JournalEuropean heart journal
Volume27
Issue number7
DOIs
StatePublished - Apr 1 2006

Keywords

  • Atrial fibrillation
  • Atrial flutter
  • Cardioversion
  • Mortality
  • Relapse

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Elesber, A. A., Rosales, A. G., Herges, R. M., Shen, W. K., Moon, B. S., Malouf, J. F., Ammash, N. M., Somers, V., Hodge, D. O., Gersh, B. J., Hammill, S. C., & Friedman, P. A. (2006). Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly. European heart journal, 27(7), 854-860. https://doi.org/10.1093/eurheartj/ehi753