Elective direct current cardioversion delay in patients with persistent atrial fibrillation/undulation: patient's characteristic and potential causes

Abstract

Fibrilacija (FA) i undulacija atrija (UA) imaju značajne zdravstvene posljedice. Sinusni je ritam moguće uspostaviti elektrokonverzijom (EK), koja se provodi nakon pripreme u svrhu prevencije tromboembolijskih komplikacija. Cilj rada bio je proučiti pristup bolesnicima s FA/UA naručenim na EK u jednom kliničkom bolničkom centru (KBC) i jednoj općoj bolnici (OB) koje oslikavaju ustanove tercijarne i sekundarne zdravstvene zaštite u Republici Hrvatskoj (RH). S tim ciljem provedena je retrospektivna analiza elektronskih i arhivskih podataka KBC Zagreb i OB Varaždin. Obuhvaćeno je 339 bolesnika (284 KBC, 55 OB). U KBC-u, priprema se temelji se na primjeni transezofagealnog ultrazvuka (modificirana u odnosu na smjernice), a u OB strategija je „klasična“ (sukladno smjernicama). Dugoročna kontrola ritma u KBC-u je sustavna (67.9%), a u OB sporadična (7.3%). Uspješnost EK (ritam) u KBC-u je viša (podešeni omjer šanse=6.51, p=0.003). U tromboprofilaksi prevladava varfarin (318/339), no dokumentacija o uspješnosti izrazito je manjkava. Uoči EK, manje od 1/3 bolesnika je adekvatno antikoagulirano. Nema sustavnih podataka o tromboembolijskim komplikacijama, pa ipak u KBC-u moždani je udar opažen u 1.5% bolesnika. Elektivna EK je rijedak terapijski postupak. Da bi se omogućila pouzdana procjena njene uspješnosti, u RH je potrebno ustrojiti sustav strukturiranog prospektivnog bilježenja pripremnih radnji (posebice tromboprofilakse) i ishoda.Atrial fibrillation (AF) and flutter (AFL) significantly reflect on morbidity and mortality. Sinus rhythm can be restored by electroconversion (EC) which requires thromboprophylaxis. The aim of this study was to assess the approach to patients with AF/AFL at one university hospital (UH) and one general hospital (GH) that represent tertiary and secondary healthcare in Croatia. We conducted a retrospective analysis of administrative databases at University Hospital Center Zagreb and General Hospital Varaždin. A total of 339 patients (284 UH, 55 GH) were embraced. Transesophageal ultrasound-assisted EC (modified vs. guidelines) is practiced at UH and a “classical” approach (in line with the guidelines) at GH. Long-term rhythm control is practiced regularly (67.9%) at UH and sporadically at GH (7.3%). The EC success rate is higher at UH (adjusted odds ratio=6.51, p=0.003). Thromboprophylaxis is almost exclusively by warfarin (318/339), but records are extremely insufficient. Immediately before EC, less than 1/3 of the patients are adequately anticoagulated. Systematic data on thromboembolic complications are non-existing, yet strokes were observed in 1.5% of the patients at UH. Elective EC is a rare procedure. To enable a reliable estimate about its efficacy in Croatia, a system of structured prospective data capturing (particularly considering thromboprohylaxis) and patient follow-up needs to be established