0230: Repeated external electrical cardioversion after a first unsuccessful attempt in persistent atrial fibrillation

Background Electrical cardioversion (EC) is a major treatment of atrial fibrillation (AF). External EC in patients with persistent AF is inefficient in 10-20% of the patients already pretreated with oral amiodarone. Patients remain usually in permanent AF. This study aims to evaluate the efficacy of repeated external ± internal EC in such patients. In case of persistent AF after a first external EC, a repeated external EC was performed. After the inefficiency of 2 external EC, internal cardioversion was perfomed. Methods Patients with persistent AF, after inefficient external EC and oral pretreatment with amiodarone were included. After a mean of 3 months, repeated external ± internal EC was proposed in order to recover sinus rhythm (SR). These patients were compared with a control group, sex and age matched, also treated with amiodarone but in whom the external EC was successful at the first attempt. The 2 groups were analyzed in a case-control study. We analyzed the rate of successful external EC after the 2 procedures in the AF group. The recurrence rate of AF was analyzed after one year in both groups. Results Twenty patients got unsuccessful external EC (mean age=64.1 years). There were 40 patients in the control group (mean age=67.1 years). External EC was repeated after a mean of 3.5±5.4 months. No patient needed internal EC. After one year, there was no difference in the recurrence rate of AF in both groups (35% vs. 27%; p=0.244, in studied and control groups, respectively). Conclusion Repeated external EC allows SR recovery in all the patients with AF under long term oral amiodarone, after a first unsuccessful external EC. The AF recurrence rate after one year was similar to patients in whom the first attempt was successful at once.