La cardioversión en la fibrilación auricular: uso actual e implicaciones clínicas

Identificador:  TDX:2790

Handle: https://hdl.handle.net/20.500.11797/TDX2790

Autors:  Viñolas Prat, Xavier

Resum:
Contributions and new knowledge provided by the thesis: It provides original information on the use of electrical cardioversion in clinical practice, different from that found in different published clinical trials. These new knowledge have relevant clinical implications. Methodology used and most relevant conclusions: In the studies conducted, data were collected prospectively and consecutively from 1,515 patients with atrial fibrillation referred to electrical cardioversion in 97 Spanish hospitals between February 1 and June 30, 2004. A descriptive statistical analysis of the different variables recorded was carried out, as well as different multi-variant analyzes to determine predictors of the complications described. The most relevant conclusions are: In routine practice, ACO is frequently used after cardioversion in patients at risk of low or moderate embolism. Comparing the messy and hemorrhagic risk, long-term OA does not seem recommended in patients with a CHADS2 score of 1 (when it is 75 years old) or 0 who remain in RS after the first month of cardioversion. The absence of obesity, the time of evolution of AF less than one year and the absence of structural heart disease were identified as predictors of reversal to RS. Patients referred to cardioversion in Spain have a lower cardiovascular risk profile than patients included in the AFFIRM study and apparently lower than in the RACE study. In routine practice, after effective electrical cardioversion for persistent AF in patients without structural heart disease, the vast majority receive antiarrhythmic drugs, mainly amiodarone. Its use is the main factor related to the maintenance of sinus rhythm 1 year later. CS was related to the success of CVD in patients treated with monophasic energy, while we did not identify any predictor in patients treated with biphasic energy. Biphasic energy was more effective in patients with high SC.