Clinical Effectiveness of Antiarrhythmic Treatment After Electrical Cardioversion in Patients Without Structural Heart Disease

The aim was to investigate the clinical practice of using antiarrhythmic drugs after electrical cardioversion in patients without structural heart disease and their effect on the maintenance of sinus rhythm. In total, 528 patients with persistent atrial fibrillation but without significant structural heart disease who underwent successful electrical cardioversion at 96 Spanish hospitals were followed up for 1 year. Patients were assessed at 1, 3, 6, and 12 months. The use and effectiveness of antiarrhythmic drugs for preventing the recurrence of persistent atrial fibrillation was evaluated. Some 80% of patients were receiving antiarrhythmic drugs at discharge, most frequently amiodarone. No specific clinical factor was associated with greater use of antiarrhythmics. Overall, 37% of patients were in sinus rhythm at all follow-up assessments. At the 1-year assessment, 59% of patients who remained in sinus rhythm were still taking antiarrhythmic drugs. Multivariate Cox regression analysis identified weight (hazard ratio [HR]=1.01 per kg; P=.04) and no antiarrhythmic treatment (HR=1.59; P=.001) as being independently associated with the recurrence of persistent atrial fibrillation. Amiodarone tended to be better than other antiarrhythmic drugs. In routine clinical practice, the large majority of patients without structural heart disease received antiarrhythmic drugs, most frequently amiodarone, after successful electrical cardioversion. Drug use was the principal factor associated with the maintenance of sinus rhythm at 1 year. Conocer en la práctica clínica el uso de antiarrítmicos tras cardioversión eléctrica en pacientes sin cardiopatía y su repercusión en el mantenimiento del ritmo sinusal. Se realizó un seguimiento a un año de 528 pacientes con fibrilación auricular persistente sin cardiopatía significativa tras una cardioversión eléctrica efectiva en 96 hospitales españoles, con controles clínicos 1, 3, 6 y 12 meses después. Se analizó el uso y la utilidad de los fármacos antiarrítmicos en la prevención de recurrencias de fibrilación auricular persistente. Se trató al alta con fármacos antiarrítmicos al 80% de los pacientes, y el más utilizado fue la amiodarona. Ningún factor clínico se relacionó con un mayor uso de antiarrítmicos. El 37% de los pacientes siguió en ritmo sinusal en todos los controles. En el control a los 12 meses, se mantuvo el tratamiento antiarrítmico al 59% de los pacientes que seguían en ritmo sinusal. En el análisis multivariable d