Sinus Bradycardia and Sinus Pauses Immediately after Electrical Cardioversion of Persistent Atrial Fibrillation—What Do They Mean?

Authors

  • Dritan Poçi M.D.,

    Corresponding author
    1. Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
    • Department of Cardiology, University Hopsital Örebro, Örebro, Sweden
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  • Britt-Marie Abrahamsson R.N.,

    1. Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Nils Edvardsson M.D., Ph.D.,

    1. Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Lennart Bergfeldt M.D., Ph.D.

    1. Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • This study was supported by grants from the Gothenburg Medical Association, the Sahlgrenska University Hospital, and the Swedish Heart Lung Foundation.

Address for correspondence: Dritan Poçi, M.D., Ph.D., Department of Cardiology, University Hospital, Örebro, Sweden.

E-mail: dritan.poci@orebroll.se

Abstract

Background

To determine the role of sinus bradyarrhythmia (SB) immediately after electrical cardioversion of persistent atrial fibrillation (AF) on the short-term recurrence rate and long-term pacemaker need and all-cause mortality.

Methods

SB defined as sinus bradycardia (sinus rate <40 bpm for ≥2 consecutive cycles) and/or sinus pauses (>2 s), were recorded during 5 minutes immediately after successful DC cardioversion in 140 consecutive patients with persistent AF.

Results

SB was observed during the first minute of SR in 31 patients (22%). Sinus bradycardia was present in 27 patients, sinus pauses in 16 (>3 s in 10) patients, and both in 12 patients. Compared to patients without SB, the mean heart rate during the first minute after cardioversion was lower, 57 ± 13 versus 63 ± 11 bpm; P < 0.05, while the mean heart rates during the subsequent 4 minutes were not statistically significantly different. The AF recurrence rates were not significantly different at 1 week (45% vs. 40%), or at 3 months (68% vs. 53%) in patients with or without SB. After a mean follow-up of 86 ± 6 months the pacemaker implantation rate was 10% versus 11% (NS) and an all-cause mortality of 26 versus 18% (NS).

Conclusions

SB immediately after electrical cardioversion of persistent AF had no significant impact on the 3-month AF recurrence rate, the long-term need for pacemaker or all-cause mortality.

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