Abstract 13425: Outcomes of Delayed vs Early Cardioversion in Patients With Paroxysmal Atrial Fibrillation: A Population-Based Study (2015-2020)

Introduction: Data on clinical outcomes of Delayed Cardioversion (DCV) compared to Early Cardioversion (ECV) in patients with paroxysmal atrial fibrillation (PAF) remains limited.

Hypothesis: Is there a difference in clinical outcomes between both procedures?

Methods: We used the National Inpatient Sample database by utilizing ICD-10 codes to identify all hospitalizations with a diagnosis of PAF and cardioversion (CV) (2015-2020). The associations between the time of CV and outcomes were examined using multivariable logistic or generalized linear model regression. Propensity-score matched (PSM) analysis was utilized to determine adjusted odds ratio (aOR) of major clinical outcomes.

Results: A total of 17,879 patients with PAF were included: 9,725 (54.4%) and 8,154 (45.6%) underwent ECV and DCV, respectively. Regarding inpatient mortality, there was no significant difference between both groups (aOR 0.81 [0.52-1.25], p=0.76). Considering cardiovascular outcomes, DCV was more associated with acute heart failure (AHF) (aOR 1.79 [1.67-1.92], p<0.01) with no significant difference in cardiac arrest (aOR 1.16 [0.73-1.84], p=0.38), cardiogenic shock (aOR 0.83 [0.59-1.17], p=0.97), need for permeant pacemaker (aOR 1.18 [0.91-1.54], p= 0.13), and arrhythmias (supraventricular and ventricular tachycardia) (aOR 0.97 [0.86-1.10], p=0.98) compared to ECV. As to neurological outcomes, there was no difference between both groups including transient ischemic attack (aOR 1.58 [0.82-3.04], p=0.12), ischemic stroke (aOR 1.06 (0.59-1.90), p=0.77), and hemorrhagic stroke (aOR 1.35 [0.36-5.07], p=0.45). Compared to ECV, DCV was associated with a higher median length of stay (4 days vs. 2 days, p<0.01) and cost of hospitalization ($33,410 vs. $21,738, p<0.01).

Conclusions: Compared to ECV, DCV was associated with more AHF and resource utilization without significant differences in inpatient mortality and other major cardiovascular and neurological outcomes.