Poor maintenance of sinus rhythm after electrical cardioversion of patients with atrial fibrillation or flutter: a 5-year follow-up of 268 consecutive patients.

OBJECTIVE: To report long-term results of direct current (DC)-cardioversion in unselected patients with atrial fibrillation (AF) or flutter.

DESIGN: The study was a retrospective 5-year follow-up of all patients undergoing DC-cardioversion for AF or flutter at our institution between 1993 and 1997.

RESULTS: Three hundred and eighty-five DC-cardioversions were performed in 268 patients. Two hundred and forty-nine patients underwent cardioversion for the first time. Of these, 183 (74%) were converted to sinus rhythm. During the first month of follow-up 105 (57%) relapsed into AF. Only 33 patients (13%) of the 249 patients scheduled for cardioversion remained in sinus rhythm after 1 year. In multivariate analysis arrhythmia duration was the only variable that was associated with successful cardioversion. Periprocedural complications occurred in 9.9% of the cardioversions.

CONCLUSION: In daily routine only a minority of patients will maintain sinus rhythm after DC-cardioversion for AF or flutter. Also, DC-cardioversion is not without risk. These observational data suggest a conservative approach to re-establishment of sinus rhythm in patients with AF.