Ventricular arrhythmias after atrial fibrillation electrical cardioversion: A multicenter study

Oholi Tovia-Brodie, MD; Yoav Michowitz, MD; Feras Bayya, MD; Stepan Havranek, MD; Milan Dusik, MD; Luigi Rivetti, MD; Roberto Mantovan, MD; Avi Sabbag, MD; Eyas Massalha, MD; Pietro Enea Lazzerini, MD; Iacopo Bertolozzi, MD; Giovanni Malanchini, MD; Christoffer Tobias Witt, MD; Óscar Cano, MD, PhD; Ziv Dadon, MD; Michael Ilan, MD; Pieter G. Postema, MD, PhD; Michael Glikson, MD; Moshe Rav Acha, MD, PhD

Heart Rhythm O2 (Nov 2024)

Ventricular arrhythmias after atrial fibrillation electrical cardioversion: A multicenter study

Oholi Tovia-Brodie, MD,
Yoav Michowitz, MD,
Feras Bayya, MD,
Stepan Havranek, MD,
Milan Dusik, MD,
Luigi Rivetti, MD,
Roberto Mantovan, MD,
Avi Sabbag, MD,
Eyas Massalha, MD,
Pietro Enea Lazzerini, MD,
Iacopo Bertolozzi, MD,
Giovanni Malanchini, MD,
Christoffer Tobias Witt, MD,
Óscar Cano, MD, PhD,
Ziv Dadon, MD,
Michael Ilan, MD,
Pieter G. Postema, MD, PhD,
Michael Glikson, MD,
Moshe Rav Acha, MD, PhD

Affiliations

Oholi Tovia-Brodie, MD: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
Yoav Michowitz, MD: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
Feras Bayya, MD: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
Stepan Havranek, MD: Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
Milan Dusik, MD: Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
Luigi Rivetti, MD: Department of Cardiology, S. Maria dei Battuti Hospital, Conegliano, Italy
Roberto Mantovan, MD: Department of Cardiology, S. Maria dei Battuti Hospital, Conegliano, Italy
Avi Sabbag, MD: Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel
Eyas Massalha, MD: Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel
Pietro Enea Lazzerini, MD: Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; Electroimmunology Unit, Division of Internal Medicine and Geriatrics, University Hospital Le Scotte, Siena, Italy
Iacopo Bertolozzi, MD: Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; Department of Cardiology, San Giovanni of God Hospital, Florence, Italy
Giovanni Malanchini, MD: Department of Cardiology, ASST Papa Giovanni XXIII Bergamo, Bergamo, Italy
Christoffer Tobias Witt, MD: Department of Cardiology, Aarhus University Hospital, Aahrhus, Denmark
Óscar Cano, MD, PhD: Department of Cardiology, Hospital Universitario y Politecnico La Fe, Valencia, Spain
Ziv Dadon, MD: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
Michael Ilan, MD: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
Pieter G. Postema, MD, PhD: Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
Michael Glikson, MD: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
Moshe Rav Acha, MD, PhD: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel; Address reprint requests and correspondence: Dr Moshe Rav Acha, Shaare Zedek Medical Center Cardiology Dept., Shmuel Beit 12, Jerusalem, Israel.

Journal volume & issue: Vol. 5, no. 11
pp. 813 – 820

Abstract

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Background: Ventricular arrhythmias (VAs) after atrial fibrillation (AF) electrical cardioversion (ECV) have been reported. Objective: We sought to assess incidence, timing, and clinical characteristics of patients with post-AF ECV-related VAs. Methods: Multicenter observational retrospective study including 13 centers, incorporating patients with VAs or sudden cardiac death within 10 days of ECV. The total number of ECVs performed during the collecting period was provided. Patients with pre-ECV VAs were excluded. Results: Twenty-three patients with VAs were identified out of 11,897 AF ECVs performed in 13 centers during a median 2-year period, suggesting post-ECV VA incidence of 0.2%. The patients’ mean age was 71 ± 11 years, and 13 (56.5%) were female. AF duration prior to ECV was 71 ± 54 days. Congestive heart failure and hypertension were both found in 17 (74%) patients. QT-prolonging drugs were used by 17 (74%). Index VA occurred 28.5 (interquartile range 5.5–72) hours post-ECV, including torsades de pointes, nonsustained polymorphic ventricular tachycardia, and sudden cardiac death in 17 (74%), 5 (22%), and 1 (4%) patient, respectively. Post-ECV heart rate was slower and QT duration longer compared with pre-ECV (57 ± 11 beats/min vs 113 ± 270 beats/min; P < .001; QT duration 482 ± 61 ms vs 390 ± 60 ms; P < .001). VAs reoccurred in 9 (39%) patients, 11 (interquartile range 3–13.5) hours post–index VA. Two patients had an arrhythmic death within 72 hours post-ECV. Conclusion: VAs post-AF ECV are rare, occur within 3 to 72 hours post-ECV, and are potentially fatal. Our study gives a signal of caution favoring prolonged monitoring in small subset of patients as congestive heart failure patients treated with class III antiarrhythmic drugs, with post-ECV bradycardia, especially (but not exclusively) when QT prolongation noted.

Published in Heart Rhythm O2

ISSN: 2666-5018 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/heart-rhythm-o2

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