APCU25OS2 Clinical outcome of electrical cardioversion for atrial fibrillation without transesophageal echocardiography: retrospective study

Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in adults. Electrical cardioversion is one of the initial effective interventions for rhythm control of AF alongside an antiarrhythmic agent. At our centre, the protocol for elective electrical cardioversion requires the patient to take an oral anticoagulant for at least six weeks before the procedure, and transesophageal echocardiography is not needed to assess the left atrial appendage clot. During the day of the procedure, the patient will undergo the procedure under conscious sedation, given intravenous amiodarone 150mg slow bolus, and given electrical cardioversion up to 270J, with a maximum of three times. Our objective is to analyze the outcome of elective cardioversion in our centre.Methods This was a retrospective cross-sectional study conducted at a single centre among patients who underwent elective electrical cardioversion between January and December 2024. The data, including demographics, comorbidities, and types of atrial fibrillation, were collected from the patient‘s notes. The immediate success and complications were evaluated. These data were analyzed using descriptive statistics in SPSS version 29.Results A total of 36 patients were included in the analysis. The mean age was 62.6 (± 10.4) years, with a predominant male gender (75%). In regards of comorbidities, in our study population, hypertension (72.2%), dyslipidemia (41.7%), diabetes mellitus (30.6%), ischemic heart disease (27.8%), heart failure (13.9%), chronic kidney disease (5.6%), hyperthyroid (13.9%), ischemic stroke (5.6%) and obstructive sleep apnea (2.8%). The majority of our patients had a persistent atrial fibrillation (88.9%) with a mean left atrial size of 5.03 ( ± 0.81) cm. Regarding clinical outcome, the immediate success rate was (77.8%). Regarding immediate complications, bradycardia (8.4%) and hypotension (2.8%) were observed, which were self-limiting. There was no incidence of stroke observed in this analysis.Conclusion Based on our experience, electrical cardioversion can be considered as one of the treatment options for rhythm control management. The most important finding in this analysis is that there was no increased incidence of stroke, despite no transesophageal echocardiography for LAA clot assessment being performed.