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Immediate reinitiation of atrial fibrillation after electrical cardioversion predicts subsequent pharmacologic and electrical conversion to sinus rhythm on amiodarone

      Up to 20% of patients with persistent atrial fibrillation (AF) resist external electrical cardioversion either because the shock fails to terminate AF or because of immediate reinitiation of AF. In these resistant patients, antiarrhythmic drug pretreatment may enhance cardioversion.
      • Boriani G.
      • Biffi M.
      • Capucci A.
      • Bronzetti G.
      • Ayers G.M.
      • Zannoli R.
      • Branzi A.
      • Magnani B.
      Favorable effects of flecainide in transvenous internal cardioversion of atrial fibrillation.
      In our institution, these patients undergo amiodarone loading followed by repeated electrical cardioversion. It is important to know beforehand which patients will respond and in which patients this procedure will be futile. We hypothesised that immediate reinitiation of AF identifies patients in whom amiodarone loading and repeated electrical cardioversion is successful in restoring and maintaining sinus rhythm. Therefore, our aim was to study in persistent AF patients with an unsuccessful electrical cardioversion whether immediate reinitiation of AF predicts subsequent successful conversion after amiodarone loading. In addition, we studied long-term maintenance of sinus rhythm in this group of patients.
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