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Spontaneous conversion of patients with atrial fibrillation scheduled for electrical cardioversion

An ACUTE trial ancillary study

S. Ahmed Tejan-Sie, MD^*, R. Daniel Murray, PhD^*, Ian W. Black, MD, Susan E. Jasper, RN^*, Carolyn Apperson-Hansen, MStat, Jianbo Li, MS, PhD, Elizabeth A. Lieber, BA, Richard A. Grimm, DO^*, Allan L. Klein, MD^*,* ACUTE Investigators

^* Departments of Cardiovascular Medicine, Cleveland, Ohio, USA
Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Medicine, University of Sydney, Sydney, Australia

View larger version (23K): [in a new window]   Figure 1 Branch tree diagram illustrating enrollment and assignment of Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) patients and how patients with spontaneous conversion to sinus rhythm were identified for the analysis. Patients were randomly assigned to either the transesophageal echocardiogram (TEE)-guided or conventional treatment groups. In the TEE arm, patients who underwent SC either before TEE-guided direct current cardioversion (DCC) or who had no TEE were enrolled in the ancillary study. In the conventional arm, patients who underwent SC before DCC were enrolled. Patients who were in the DCC not-done category and did not have spontaneous conversion had other outcomes such as medical complications, surgery, or thrombi or were not therapeutically anticoagulated. AAA* = antiarrhythmic agents: Vaughn-Williams type 1 and 3; patients on these agents were excluded from the analysis.

View larger version (11K): [in a new window]   Figure 2 Frequency of patients who underwent spontaneous conversion (SC) to sinus rhythm related to duration of pre-existing atrial fibrillation (AF) prior to enrollment. This graph shows patients with pre-existing AF of one week or less were more likely to have SC. Less than 10% of the SC patients had pre-existing AF more than 12 weeks (not shown).

View larger version (23K): [in a new window]   Figure 3 Proportion of patients who underwent spontaneous conversion (SC) to sinus rhythm in the first week following enrollment. The bars represent the proportion of patients who underwent SC to sinus rhythm on a particular day and are subdivided into transesophageal echocardiography-guided (TEE) (striped bars) and conventional (speckled bars) groups. Most patients underwent SC in the first day following enrollment.