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CLINICAL STUDY

early recurrence of atrial fibrillation after ambulatory shock conversion

David Schwartzman, MD FACC^*,*, Shailesh Kumar Musley, PhD, Charles Swerdlow, MD, FACC, Robert H. Hoyt, MD, FACC and Eduardo N. Warman, PhD

^* Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Medtronic Inc., Minneapolis, Minnesota, USA
Cedars-Sinai Medical Center, Los Angeles, California, USA
Iowa Heart Center, Des Moines, Iowa, USA

Manuscript received October 11, 2001; revised manuscript received March 27, 2002, accepted April 5, 2002.

^* Reprint requests and correspondence: Dr. David Schwartzman, Cardiovascular Institute, Presbyterian University Hospital, B535, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213-2582, USA.
schwartzmand{at}msx.upmc.edu

OBJECTIVES: We sought to gain insights into the early recurrence of atrial fibrillation (ERAF) after cardioversion shocks delivered by permanently implanted rhythm management systems.

BACKGROUND: Several reports have characterized ERAF, but these reports used a limited definition and did not evaluate an association between clinical or device variables and ERAF.

METHODS: A total of 144 patients with recurrent, drug-resistant, symptomatic atrial fibrillation (AF) underwent implantation of an atrial rhythm management system (Medtronic Jewel AF, Model 7250, Minneapolis, Minnesota). The device was programmed to deliver cardioversion shocks automatically and/or on patient command. The incidence of ERAF was evaluated after 1,092 successful shocks among 97 patients. Three different ERAF definitions were used: recurrence within 1 min, 1 h or 1 day. Multiple clinical and device variables were assessed for their relationship with ERAF.

RESULTS: The per-patient incidences of ERAF were 44%, 61% and 70% for ERAF within 1 min, 1 h and 1 day, respectively. The per-episode incidences of ERAF were 17%, 30% and 43% for ERAF within 1 min, 1 h and 1 day, respectively. Variables that were independently associated with ERAF included AF duration <3 h before termination, more than one shock required to cardiovert and the absence of a previous myocardial infarction. The most potent variable was AF duration <3 h, associated with a threefold increase in the incidence of ERAF.

CONCLUSIONS: Recurrence of AF early after ambulatory shock cardioversion is common. In this retrospective study, both clinical and device variables were predictive.

Abbreviations and Acronyms   AF   atrial fibrillation   CI   confidence interval   ERAF   early recurrence of atrial fibrillation   ERAF1 min   successful shock followed by AF within 1 min   ERAF1 h   successful shock followed by AF within 1 h   ERAF1 day   successful shock followed by AF within 24 h   GEE   generalized estimating equation

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