Sex, age, and time to cardioversion. Risk factors for cardioversion of acute atrial fibrillation from the FinCV study.

Abstract:

BACKGROUND:Female sex, old age, and time to cardioversion increase the risk of thromboembolic complications (TEC) after cardioversion of atrial fibrillation (AF) < 48 h. The interaction of these variables is not known. We investigated the interaction of sex, age, and time to electrical cardioversion (ECV) on TEC in anticoagulant-naive patients with acute AF. METHODS AND RESULTS:The primary outcome was a TEC within 30 days following ECV. Patients were divided into three age groups and time to cardioversion into <12 h and ≥12 h in 4715 ECVs. TEC occurred in 40 (0.8%) patients. In multivariate analysis, female sex, time to ECV, and vascular disease were independent predictors of TEC. For patients ≤75 cardioverted within 12 h, the incidence of TEC was low. In patients >75 TEC increased in both sexes and particularly in women (1.4% vs. 0.9%, p = 0.03). When ECVs exceeded 12 h, the risk of TEC was two- to four-fold higher in women in all age groups. CONCLUSIONS:The risk of TEC increases substantially in patients >75 and ECVs ≥12 h, particularly in women. Time to cardioversion should be added to risk-stratification of ECVs of acute AF. Key messages The ideal timing of cardioversion is still unknown and not based on solid evidence. Delay to cardioversion ≥12 h should be added to the risk stratification of atrial fibrillation cardioversion. Female sex increases the risk of complications and failure of cardioversion after electrical cardioversion of atrial fibrillation <48 h, especially with age >75 years and time to cardioversion exceeding 12 h.

journal_name

Ann Med

journal_title

Annals of medicine

authors

Bah A,Nuotio I,Grönberg T,Ylitalo A,Airaksinen KE,Hartikainen JE

doi

10.1080/07853890.2016.1267869

subject

Has Abstract

pub_date

2017-05-01 00:00:00

pages

254-259

issue

3

eissn

0785-3890

issn

1365-2060

journal_volume

49

pub_type

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