Ventricular arrhythmias after atrial fibrillation electrical cardioversion: A multicenter study

Fecha de publicación: 01/11/2024 Fecha Ahead of Print: 01/11/2024

Autores de IIS La Fe

• Óscar Cano Pérez

  Autor

Participantes ajenos a IIS La Fe

• Tovia-Brodie, Oholi
• Michowitz, Yoav
• Bayya, Feras
• Havranek, Stepan
• Dusik, Milan
• Rivetti, Luigi
• Mantovan, Roberto
• Sabbag, Avi
• Massalha, Eyas
• Lazzerini, Pietro Enea
• Bertolozzi, Iacopo
• Malanchini, Giovanni
• Witt, Christoffer Tobias
• Dadon, Ziv
• Ilan, Michael
• Postema, Pieter G.
• Glikson, Michael
• Acha, Moshe Rav

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

  

  Investigador Principal

  Esther Roselló Lletí

Abstract

BACKGROUND Ventricular arrhythmias (VAs) after atrial fi brilla- tion (AF) electrical cardioversion (ECV) have been reported. OBJECTIVE We sought to assess incidence, timing, and clinical characteristics of patients with post-AF ECV-related VAs. METHODS Multicenter observational retrospective study including 13 centers, incorporating patients with VAs or sudden cardiac death within 10 days of ECV. The total number of ECVs performed during the collecting period was provided. Patients with pre-ECV VAs were excluded. RESULTS Twenty-three patients with VAs were identified out of 11,897 AF ECVs performed in 13 centers during a median 2-year period, suggesting post-ECV VA incidence of 0.2%. The patients' mean age was 71 +/- 11 years, and 13 (56.5%) were female. AF duration prior to ECV was 71 +/- 54 days. Congestive heart failure and hypertension were both found in 17 (74%) patients. QT-prolonging drugs were used by 17 (74%). Index VA occurred 28.5 (interquartile range 5.5-72) hours post-ECV, including torsades de pointes, non- sustained polymorphic ventricular tachycardia, and sudden cardiac death in 17 (74%), 5 (22%), and 1 (4%) patient, respectively. Post ECV heart rate was slower and QT duration longer compared with pre-ECV (57 +/- 11 beats/min vs 113 +/- 270 beats/min; P < .001; QT duration 482 +/- 61 ms vs 390 +/- 60 ms; P < .001). VAs reoccurred in 9 (39%) patients, 11 (interquartile range 3-13.5) hours post- index VA. Two patients had an arrhythmic death within 72 hours post-ECV. CONCLUSION VAs post-AF ECV are rare, occur within 3 to 72 hours post-ECV, and are potentially fatal. Our study gives a signal of caution favoring prolonged monitoring in small subset of patients as congestive heart failure patients treated with class III antiarrhythmic drugs, with post-ECV bradycardia, especially (but not exclusively) when QT prolongation noted.

Keywords

• Atrial fibrillation; Electrical cardioversion; Monitoring; Ventricular arrhythmia