European Heart Journal Advance Access originally published online on February 2, 2006
European Heart Journal 2006 27(7):854-860; doi:10.1093/eurheartj/ehi753
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Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly
1Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
2Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
Received 6 July 2005; revised 15 December 2005; accepted 13 January 2006; online publish-ahead-of-print 2 February 2006.
* Corresponding author. Tel: +1 507 255 2446; fax: +1 507 255 2550. E-mail address: friedman.paul{at}mayo.edu
Aims Trials of rate control vs. rhythm control for atrial fibrillation or flutter included few patients with new-onset arrhythmia. Our objective was to assess the relapse rate and the effect of the relapse of new-onset atrial arrhythmias on mortality after direct-current cardioversion (DCCV).
Methods and results A cohort of 351 patients with atrial fibrillation (new onset in 179) and 126 patients with atrial flutter (new onset in 78) was followed-up after DCCV. Cox proportional hazard models were used. Median age was 74.6 years. Mean follow-up for relapse was 7.7 months; for death, 29.4 months. Patients with new-onset atrial flutter [adjusted hazard ratio (HR)=1] were more likely to maintain sinus rhythm than the patients with recurrent atrial flutter (adjusted HR=2.5, P<0.01), new-onset atrial fibrillation (adjusted HR=2.4, P<0.01), or recurrent atrial fibrillation (adjusted HR=2.7, P<0.01). Patients with new-onset atrial fibrillation were as likely to have relapses as patients with recurrent atrial fibrillation or flutter. Relapse of atrial arrhythmia after DCCV was associated with increased mortality (adjusted HR=3.1, P<0.01).
Conclusion DCCV is more successful in maintaining sinus rhythm in patients with new-onset atrial flutter than in patients with new-onset atrial fibrillation. Relapse of atrial arrhythmia after cardioversion is associated with increased mortality.
Key Words: Atrial fibrillation • Atrial flutter • Cardioversion • Mortality • Relapse
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