Early electrical cardioversion for early recurrent atrial tachyarrhythmia after pulmonary vein isolation in atrial fibrillation: a global real-world analysis
L Serio, A Askarinejad, T Bucci, M Rossi, E Tartaglia, A Galeazzo Rigutini, C Weng, S H M Lam, M Alobaida, C Ferri, D Gupta, J Mandrola, G Y H LipAbstract
Background
Pulmonary vein isolation (PVI) is a well-established procedure for treating atrial fibrillation (AF); however, early recurrence of atrial tachyarrhythmias (ERAT) is common. Electrical cardioversion (ECV) is one treatment for ERAT, but optimal timing is unestablished.
Purpose
To evaluate the association between the timing of ECV for ERAT and the risk of late recurrence of atrial tachyarrhythmias (LRAT).
Methods
A retrospective cohort study using data from a global federated electronic health record network (TriNetX). We included AF patients undergoing PVI who developed ERAT within 90 days. Two ERAT periods were defined: early ERAT (days 1–30) and late ERAT (days 31–90). Within each stratum, patients were classified according to receipt of ECV versus no ECV and were 1:1 propensity score matched. The primary outcome was LRAT from day 91 to 365 post-ablation.
Results
A total of 24,623 patients with ERAT were included, of whom 1,506 underwent ECV (mean age 66.3 ± 9.5 years; 27.2% female) and 23,117 did not (mean age 64.4 ± 10.7 years; 33.1% female). After PSM, ECV was associated with statistically significant lower risk of LRAT in both early ERAT (HR 0.592; 95% CI 0.488–0.717) and late ERAT (HR 0.816; 95% CI 0.686–0.970) comparisons. After PSM, Patients who underwent ECV in early ERAT group compared to late ERAT group, had lower risk of LRAT (HR 0.80, 95% CI 0.67–0.94).
Conclusions
ECV during ERAT was associated with a lower risk of LRAT, with a stronger association in early vs late ERAT. Prospective studies should assess whether earlier ECV during the blanking period improves long-term rhythm outcomes.Forest plots outcomes pre and post matchingTimeline and one year LRAT risk (post PSM)