Chronic atrial fibrillation in intensive care unit treated with electrical cardioversion: is it appropriate?

Introduction

Chronic atrial fibrillation is known to be an important co-morbidity factor in critically ill patients admitted to the ICU. The aim of this study was to evaluate whether electrical cardioversion in the ICU can reduce mortality of patients with chronic atrial fibrillation.

Methods

From January 2005 to November 2009, 50 patients with history of chronic atrial fibrillation admitted to the ICU were retrospectively studied. Patients were divided into two groups: the first group included patients who underwent electrical cardioversion (CVE group, n = 10) and were discharged in sinus rhythm; the second included patients who did not undergo electrical cardioversion and were discharged with chronic atrial fibrillation (CAF group, n = 40). In both groups, mortality, antiarrhythmic drug therapy and oral anticoagulation regimen were monitored. The first group's follow-up evaluated maintenance of sinus rhythm. The number of DC shocks required for the maintenance of sinus rhythm in patients of the CVE group was also collected. The main outcome parameter considered was 28-day mortality.

Results

Patients of both groups resulted in similar demographic and clinical parameters. In patients included in the CVE group, the maintenance of sinus rhythm was achieved with one DC shock in 66.6%, two DC shocks in 22.2% and three DC shocks in 11.1% of cases. The mortality rate at 24 hours was 0% while at 28 days was 11.1%, whereas patients in the CAF group had a 28-day mortality rate of 35%. See Figure 1.

Figure 1

Conclusions

Our pilot study indicates that the improvement of ventricular performance with the contribution of atrial systole might improve critically ill patients' outcome. Considering the small number of cases, a prospective study, based on these preliminary results, is ongoing.