Introduction

Patients with atrial fibrillation (AF) are at increased risk of cardiovascular diseases and death. Evidence on the comparable effects of rhythm and heart rate control strategies in patients with AF is ambiguous.

Aim of the research

To assess the recurrence of arrhythmia and adverse cardiovascular events within 12 months of electrical cardioversion in patients with AF receiving oral anticoagulation therapy.

Material and methods

This was a prospective, single-centre cohort study. The participants underwent transoesophageal echocardiography before direct current cardioversion (DCC). A total of 226 patients were enrolled. The primary outcome was sinus rhythm (SR) restoration after DCC for AF. All participants were followed up for 12 months to evaluate the incidence of death, systemic thromboembolic events, stroke, acute coronary syndrome, hospitalization due to worsening heart failure (HF), and recurrence of arrhythmia after SR restoration.

Results

SR restoration was achieved after DCC in 197 (87.2 %) patients, of whom 112 (56.9%) experienced arrhythmia relapse. Significant risk factors associated with arrhythmia recurrence were -adrenergic antagonist therapy, chronic obstructive pulmonary disease, and previous stroke/transient ischaemic attack/thromboembolic events. All enrolled patients were free of acute coronary syndrome, systemic thromboembolic events, and stroke, and none of the patients died during the 12-month follow-up period. Hospitalization with worsening HF occurred in 13 patients with SR and in 10 patients with persistent AF (p = 0.42).

Conclusions

The arrhythmia recurrence rate was high; however, cardiovascular complications and deaths did not occur. The incidence of hospitalization for HF was comparable between the AF and SR groups.