Complications associated with direct-current cardioversion of atrial firbrillation and -flutter: a Danish regional quality-assurance study
Authors
Kjeldgaard, Mikkel ; Lie, Vilde Katinka Davidsen ; Al-Janabi, Nabil Luai Mahdi
Term
5. Term (Master thesis)
Education
Publication year
2022
Submitted on
2022-01-06
Pages
16
Abstract
Baggrund: Atrieflimren øger risikoen for apopleksi, og elektrisk kardioversion med jævnstrøm (DC-kardioversion) er en central behandling, men kan potentielt mobilisere tromber. Formål: Som et regionalt kvalitetssikringsstudie vurderede vi incidensen af apopleksi/tromboemboliske cerebrale hændelser, hjertestop og mortalitet samt mulige risikofaktorer i korttidsforløbet efter DC-kardioversion for atrieflimren. Metode: Ved kobling af danske landsdækkende registre identificerede vi alle voksne med atrieflimren, der fik DC-kardioversion på Regionshospital Nordjylland, Hjørring, i perioden 2016–2020. Primært analyserede vi første DC-kardioversion til sinusrytme, med supplerende analyse af gentagne procedurer. Udfald blev registreret inden for fire uger og omfattede apopleksi (iskæmisk apopleksi, TCI, arteriel emboli, uspecificeret apopleksi), hjertestop og død. På grund af meget få hændelser blev inferentiel statistik ikke anvendt; hændelser blev vurderet som enkeltsager, og rå nationale data om apopleksirisiko efter gentagne kardioversioner blev rapporteret til validering. Resultater: Blandt 962 første DC-kardioversioner blev der ikke observeret cerebrale tromboemboliske hændelser, og der forekom ét hjertestop; dødeligheden var lav. Ved gentagne procedurer blev der identificeret én cerebrovaskulær hændelse. Konklusion: Korttidskomplikationer efter DC-kardioversion for atrieflimren var sjældne i denne regionale praksis, hvilket understøtter en høj patientsikkerhed; dog begrænser det meget lave antal hændelser mulighederne for at identificere risikofaktorer og udføre robuste statistiske analyser.
Background: Atrial fibrillation increases the risk of stroke, and direct-current cardioversion (DC cardioversion) is a key treatment but may potentially mobilize atrial thrombi. Aim: In this regional quality-assurance study, we assessed the short-term incidence of stroke/thromboembolic cerebral events, cardiac arrest, and mortality, and explored possible risk factors following DC cardioversion for atrial fibrillation. Methods: Using nationwide Danish registries, we identified all adults with atrial fibrillation who underwent DC cardioversion at the North Denmark Regional Hospital, Hjørring, from 2016 to 2020. The primary analysis focused on first-time cardioversions to sinus rhythm, with an additional analysis of repeated procedures. Outcomes within four weeks included stroke (ischemic stroke, TIA, arterial embolism, unspecified stroke), cardiac arrest, and death. Because events were very rare, inferential statistics were not feasible; events were reviewed as individual cases, and crude national data on post-cardioversion stroke after repeated procedures were reported for context. Results: Among 962 first-time procedures, no cerebral thromboembolic events were observed and one cardiac arrest occurred; mortality was low. A single cerebrovascular event was identified among repeated procedures. Conclusion: Short-term complications after DC cardioversion for atrial fibrillation were rare in this regional setting, supporting a high level of patient safety; however, the very low event rate limited risk-factor analyses and robust statistical comparisons.
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