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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

View larger version (92K): [in a new window]   Figure 1 Real-time telemetered data from implanted device. An atrial cardioversion shock (arrow) is delivered, resulting in termination of atrial fibrillation (AF). However, AF recurrence is swift, occurring well within the five consecutive ventricular beats required for device determination of success. Had this been an ambulatory event, the device would have characterized it as a failed shock. As such events were not stored by the device, the incidence of this phenomenon is unknown. Aegm = atrial electrogram; EKG = surface electrocardiogram; MC = marker channel.

View larger version (17K): [in a new window]   Figure 2 Timing of onset of early recurrence of atrial fibrillation (ERAF) events. (Top) Incidence of ERAF onset over the first hour after successful shock (355 shocks, 33% of the total for the study cohort). (Bottom) Incidence of ERAF over the first 24 h after successful shock (498 shocks, 46% of the total).

View larger version (23K): [in a new window]   Figure 3 Distribution of early recurrence of atrial fibrillation (ERAF) incidence, expressed as the percentage of all successful shocks for the study cohort, based on the duration of atrial fibrillation preceding cardioversion. Data are presented as generalized estimating equation estimates; error bars indicate 95% confidence intervals. Note variations in scale between the graphs.

View larger version (23K): [in a new window]   Figure 4 Paired analysis of median duration of atrial fibrilliation (AF) preceeding cardioversion in individuals experiencing successful cardioversion shocks with and without early recurrence of atrial fibrillation (ERAF). The box plot shows the 25th and 75th percentiles. The median value is shown as a line across the box; error bars define the 10th and 90th percentiles. Note variations in graph scaling.