Is there an association between external cardioversions and long-term mortality and morbidity? Insights from the atrial fibrillation follow-up investigation of rhythm management study

Claude S. Elayi, Matthew G. Whitbeck, Richard Charnigo, Jignesh Shah, Tracy E. Macaulay, Gustavo Morales, John C. Gurley, Bahram Kakavand, Sergio Thal, Chi Keong Ching, Yaariv Khaykin, Atul Verma, Conor Barrett, Rong Bai, Luigi Di Biase, Abhijit Patwardhan, David J. Moliterno, Andrea Natale

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background-Cardiac electric therapies effectively terminate tachyarrhythmias. Recent data suggest a possible increase in long-term mortality associated with implantable cardioverter-defibrillator shocks. Little is known about the association between external cardioversion episodes (ECVe) and long-term mortality. We sought to assess the safety of repeated ECVe with regard to cardiovascular mortality and morbidity. Methods and Results-We analyzed the data of the 4060 patients from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. In particular, associations of ECVe with all-cause mortality, cardiovascular mortality, and hospitalizations after ECVe were studied. Over an average follow-up of 3.5 years, 660 (16.3%) patients died, 331 (8.2%) from cardiovascular causes. A total of 207 (5.1%) and 1697 (41.8%) patients had low ejection fraction and nonparoxysmal atrial fibrillation, respectively; 2460 patients received no ECVe, whereas 1600 experienced ≥1 ECVe. Death occurred in 412 (16.7%), 196 (16.5%), 39 (13.5%), and 13 (10.4%) of patients with 0, 1, 2, and ≥3 ECVe, respectively. There was no significant association between ECVe and mortality within any of the 4 subgroups defined by ejection fraction and atrial fibrillation type, although myocardial infarction, coronary artery bypass graft, and digoxin were significantly associated with death (estimated hazard ratios, 1.65, 1.59, and 1.62, respectively; P<0.0001). ECVe were associated with increased cardiac hospitalization reported at the next follow-up visit (39.3% versus 5.8%; estimated odds ratio, 1.39; P<0.0001). Conclusions-In the AFFIRM study, there was no significant association between ECVe and long-term mortality, even though ECVe were associated with increased hospitalizations from cardiac causes. Digoxin, myocardial infarction, and coronary artery bypass graft were significantly associated with mortality.

Original languageEnglish (US)
Pages (from-to)465-469
Number of pages5
JournalCirculation: Arrhythmia and Electrophysiology
Volume4
Issue number4
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Electric Countershock
Atrial Fibrillation
Morbidity
Mortality
Hospitalization
Digoxin
Coronary Artery Bypass
Myocardial Infarction
Transplants
Implantable Defibrillators
Tachycardia
Shock
Odds Ratio

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Cardioversion
  • Death
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Is there an association between external cardioversions and long-term mortality and morbidity? Insights from the atrial fibrillation follow-up investigation of rhythm management study. / Elayi, Claude S.; Whitbeck, Matthew G.; Charnigo, Richard; Shah, Jignesh; Macaulay, Tracy E.; Morales, Gustavo; Gurley, John C.; Kakavand, Bahram; Thal, Sergio; Ching, Chi Keong; Khaykin, Yaariv; Verma, Atul; Barrett, Conor; Bai, Rong; Di Biase, Luigi; Patwardhan, Abhijit; Moliterno, David J.; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 4, No. 4, 08.2011, p. 465-469.

Research output: Contribution to journalArticle

Elayi, CS, Whitbeck, MG, Charnigo, R, Shah, J, Macaulay, TE, Morales, G, Gurley, JC, Kakavand, B, Thal, S, Ching, CK, Khaykin, Y, Verma, A, Barrett, C, Bai, R, Di Biase, L, Patwardhan, A, Moliterno, DJ & Natale, A 2011, 'Is there an association between external cardioversions and long-term mortality and morbidity? Insights from the atrial fibrillation follow-up investigation of rhythm management study', Circulation: Arrhythmia and Electrophysiology, vol. 4, no. 4, pp. 465-469. https://doi.org/10.1161/CIRCEP.110.960591
Elayi, Claude S. ; Whitbeck, Matthew G. ; Charnigo, Richard ; Shah, Jignesh ; Macaulay, Tracy E. ; Morales, Gustavo ; Gurley, John C. ; Kakavand, Bahram ; Thal, Sergio ; Ching, Chi Keong ; Khaykin, Yaariv ; Verma, Atul ; Barrett, Conor ; Bai, Rong ; Di Biase, Luigi ; Patwardhan, Abhijit ; Moliterno, David J. ; Natale, Andrea. / Is there an association between external cardioversions and long-term mortality and morbidity? Insights from the atrial fibrillation follow-up investigation of rhythm management study. In: Circulation: Arrhythmia and Electrophysiology. 2011 ; Vol. 4, No. 4. pp. 465-469.
@article{afdd722697644e0395aeae8e0b4bd6c9,
title = "Is there an association between external cardioversions and long-term mortality and morbidity?: Insights from the atrial fibrillation follow-up investigation of rhythm management study",
abstract = "Background-Cardiac electric therapies effectively terminate tachyarrhythmias. Recent data suggest a possible increase in long-term mortality associated with implantable cardioverter-defibrillator shocks. Little is known about the association between external cardioversion episodes (ECVe) and long-term mortality. We sought to assess the safety of repeated ECVe with regard to cardiovascular mortality and morbidity. Methods and Results-We analyzed the data of the 4060 patients from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. In particular, associations of ECVe with all-cause mortality, cardiovascular mortality, and hospitalizations after ECVe were studied. Over an average follow-up of 3.5 years, 660 (16.3{\%}) patients died, 331 (8.2{\%}) from cardiovascular causes. A total of 207 (5.1{\%}) and 1697 (41.8{\%}) patients had low ejection fraction and nonparoxysmal atrial fibrillation, respectively; 2460 patients received no ECVe, whereas 1600 experienced ≥1 ECVe. Death occurred in 412 (16.7{\%}), 196 (16.5{\%}), 39 (13.5{\%}), and 13 (10.4{\%}) of patients with 0, 1, 2, and ≥3 ECVe, respectively. There was no significant association between ECVe and mortality within any of the 4 subgroups defined by ejection fraction and atrial fibrillation type, although myocardial infarction, coronary artery bypass graft, and digoxin were significantly associated with death (estimated hazard ratios, 1.65, 1.59, and 1.62, respectively; P<0.0001). ECVe were associated with increased cardiac hospitalization reported at the next follow-up visit (39.3{\%} versus 5.8{\%}; estimated odds ratio, 1.39; P<0.0001). Conclusions-In the AFFIRM study, there was no significant association between ECVe and long-term mortality, even though ECVe were associated with increased hospitalizations from cardiac causes. Digoxin, myocardial infarction, and coronary artery bypass graft were significantly associated with mortality.",
keywords = "Arrhythmia, Atrial fibrillation, Cardioversion, Death, Heart failure",
author = "Elayi, {Claude S.} and Whitbeck, {Matthew G.} and Richard Charnigo and Jignesh Shah and Macaulay, {Tracy E.} and Gustavo Morales and Gurley, {John C.} and Bahram Kakavand and Sergio Thal and Ching, {Chi Keong} and Yaariv Khaykin and Atul Verma and Conor Barrett and Rong Bai and {Di Biase}, Luigi and Abhijit Patwardhan and Moliterno, {David J.} and Andrea Natale",
year = "2011",
month = "8",
doi = "10.1161/CIRCEP.110.960591",
language = "English (US)",
volume = "4",
pages = "465--469",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Is there an association between external cardioversions and long-term mortality and morbidity?

T2 - Insights from the atrial fibrillation follow-up investigation of rhythm management study

AU - Elayi, Claude S.

AU - Whitbeck, Matthew G.

AU - Charnigo, Richard

AU - Shah, Jignesh

AU - Macaulay, Tracy E.

AU - Morales, Gustavo

AU - Gurley, John C.

AU - Kakavand, Bahram

AU - Thal, Sergio

AU - Ching, Chi Keong

AU - Khaykin, Yaariv

AU - Verma, Atul

AU - Barrett, Conor

AU - Bai, Rong

AU - Di Biase, Luigi

AU - Patwardhan, Abhijit

AU - Moliterno, David J.

AU - Natale, Andrea

PY - 2011/8

Y1 - 2011/8

N2 - Background-Cardiac electric therapies effectively terminate tachyarrhythmias. Recent data suggest a possible increase in long-term mortality associated with implantable cardioverter-defibrillator shocks. Little is known about the association between external cardioversion episodes (ECVe) and long-term mortality. We sought to assess the safety of repeated ECVe with regard to cardiovascular mortality and morbidity. Methods and Results-We analyzed the data of the 4060 patients from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. In particular, associations of ECVe with all-cause mortality, cardiovascular mortality, and hospitalizations after ECVe were studied. Over an average follow-up of 3.5 years, 660 (16.3%) patients died, 331 (8.2%) from cardiovascular causes. A total of 207 (5.1%) and 1697 (41.8%) patients had low ejection fraction and nonparoxysmal atrial fibrillation, respectively; 2460 patients received no ECVe, whereas 1600 experienced ≥1 ECVe. Death occurred in 412 (16.7%), 196 (16.5%), 39 (13.5%), and 13 (10.4%) of patients with 0, 1, 2, and ≥3 ECVe, respectively. There was no significant association between ECVe and mortality within any of the 4 subgroups defined by ejection fraction and atrial fibrillation type, although myocardial infarction, coronary artery bypass graft, and digoxin were significantly associated with death (estimated hazard ratios, 1.65, 1.59, and 1.62, respectively; P<0.0001). ECVe were associated with increased cardiac hospitalization reported at the next follow-up visit (39.3% versus 5.8%; estimated odds ratio, 1.39; P<0.0001). Conclusions-In the AFFIRM study, there was no significant association between ECVe and long-term mortality, even though ECVe were associated with increased hospitalizations from cardiac causes. Digoxin, myocardial infarction, and coronary artery bypass graft were significantly associated with mortality.

AB - Background-Cardiac electric therapies effectively terminate tachyarrhythmias. Recent data suggest a possible increase in long-term mortality associated with implantable cardioverter-defibrillator shocks. Little is known about the association between external cardioversion episodes (ECVe) and long-term mortality. We sought to assess the safety of repeated ECVe with regard to cardiovascular mortality and morbidity. Methods and Results-We analyzed the data of the 4060 patients from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. In particular, associations of ECVe with all-cause mortality, cardiovascular mortality, and hospitalizations after ECVe were studied. Over an average follow-up of 3.5 years, 660 (16.3%) patients died, 331 (8.2%) from cardiovascular causes. A total of 207 (5.1%) and 1697 (41.8%) patients had low ejection fraction and nonparoxysmal atrial fibrillation, respectively; 2460 patients received no ECVe, whereas 1600 experienced ≥1 ECVe. Death occurred in 412 (16.7%), 196 (16.5%), 39 (13.5%), and 13 (10.4%) of patients with 0, 1, 2, and ≥3 ECVe, respectively. There was no significant association between ECVe and mortality within any of the 4 subgroups defined by ejection fraction and atrial fibrillation type, although myocardial infarction, coronary artery bypass graft, and digoxin were significantly associated with death (estimated hazard ratios, 1.65, 1.59, and 1.62, respectively; P<0.0001). ECVe were associated with increased cardiac hospitalization reported at the next follow-up visit (39.3% versus 5.8%; estimated odds ratio, 1.39; P<0.0001). Conclusions-In the AFFIRM study, there was no significant association between ECVe and long-term mortality, even though ECVe were associated with increased hospitalizations from cardiac causes. Digoxin, myocardial infarction, and coronary artery bypass graft were significantly associated with mortality.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Cardioversion

KW - Death

KW - Heart failure

UR - http://www.scopus.com/inward/record.url?scp=80054028237&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054028237&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.110.960591

DO - 10.1161/CIRCEP.110.960591

M3 - Article

C2 - 21511994

AN - SCOPUS:80054028237

VL - 4

SP - 465

EP - 469

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 4

ER -