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https://hdl.handle.net/2440/119870
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dc.contributor.author | Voskoboinik, A. | - |
dc.contributor.author | Kalman, E. | - |
dc.contributor.author | Plunkett, G. | - |
dc.contributor.author | Knott, J. | - |
dc.contributor.author | Moskovitch, J. | - |
dc.contributor.author | Sanders, P. | - |
dc.contributor.author | Kistler, P. | - |
dc.contributor.author | Kalman, J. | - |
dc.date.issued | 2019 | - |
dc.identifier.citation | International Journal of Cardiology, 2019; 284:33-37 | - |
dc.identifier.issn | 0167-5273 | - |
dc.identifier.issn | 1874-1754 | - |
dc.identifier.uri | http://hdl.handle.net/2440/119870 | - |
dc.description.abstract | BACKGROUND:Due to barriers to accessing timely elective electrical cardioversion (CV) for persistent AF (PeAF), we adopted a policy of instructing patients to present directly to the Emergency Department (ED) for CV. OBJECTIVE:We compare a strategy of Emergency CV (ED-CV) versus Elective CV (EL-CV) for treatment of symptomatic PeAF. METHODS:Between 2014 and 7, we evaluated 150 patients undergoing CV for PeAF. ED-CV patients were provided an AF action plan for recurrent symptoms and advised to present to ED within 36 h. EL-CV patients followed standard care, including cardiologist referral and placement on an elective hospital waiting list. Follow-up was 12 months. RESULTS:We included 75 consecutive ED-CV patients and 75 consecutive EL-CV patients. ED-CV patients had a significantly shorter median AF duration prior to CV (1 day vs 3 months; p < 0.01) and less overall AF-related symptoms at 12 months (modified EHRA symptom score ≥ 2a in 44% vs 72%; p = 0.005). Time to next AF recurrence was longer in the ED-CV group (295 ± 15 vs 245 ± 15 days; logrank p = 0.001), as was time to AF ablation referral (314 ± 13 vs 276 ± 15 days; logrank p = 0.01). Baseline LA area was similar (ED-CV 27 ± 4 cm2 vs EL-CV 28 ± 11 cm2; p = 0.67), however EL-CV had larger atria at follow-up (31 ± 8 vs 26 ± 6 cm2; p = 0.01). There were no complications in either group. CONCLUSION:ED-CV is an acceptable strategy for symptomatic PeAF. In addition to reduced time spent in AF and improved symptom scores, this strategy may also slow progression of atrial substrate & delay onset of next AF episode. | - |
dc.description.statementofresponsibility | Aleksandr Voskoboinik, Elana Kalman, George Plunkett, Jonathan Knott, Jeremy Moskovitch, Prashanthan Sanders, Peter M. Kistler, Jonathan M. Kalman | - |
dc.language.iso | en | - |
dc.publisher | Elsevier | - |
dc.rights | © 2018 Published by Elsevier B.V. | - |
dc.source.uri | http://dx.doi.org/10.1016/j.ijcard.2018.10.068 | - |
dc.subject | Atrial fibrillation | - |
dc.subject | Atrial remodelling | - |
dc.subject | Electrical cardioversion | - |
dc.subject | Left atrium | - |
dc.title | A comparison of early versus delayed elective electrical cardioversion for recurrent episodes of persistent atrial fibrillation: a multi-center study | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1016/j.ijcard.2018.10.068 | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Sanders, P. [0000-0003-3803-8429] | - |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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