The Risk of Cardiovascular Events in Patiens with Atrial Fibrillation after Electrical Cardioversion

Aldis Strelnieks2, Iveta Sime3, Irina Pupkevica2, Marina Kovalova4, Irina Cgojeva-Sproge1, Janis Pudulis2, Natalija Nikrus4, Aivars Lejnieks5, Oskars Kalejs1,2
1 Latvian Centre of Cardiology, Riga Stradins University, P.Stradins University Hospital, Latvia
2 Department of Internal Medicine, Riga Stradins University, Riga East University Hospital, Latvia
3 Internal Medicine, Liepaja Regional Hospital, Latvia
4 Internal Medicine, Jelgava Regional Hospital, Latvia

The goal of studies: To evaluate clinical episodes in pts after electrical cardioversion (ECV) according to the cardiovascular risk factors, CHA2DS2- VASc scale and pharmacotherapeutical methods with the use of different oral anticoagulants.

Material and Methods: 260 prospective and 225 retrospective pts with atrial fibrillation, who had an ECV in 2013 in Latvian Centre of Cardiology.

Results: The most common cardiovascular risk factor was found to be arterial hypertension (AH) (83,1%), chronic heart failure (CHF) (66,6%) and metabolyc syndrome (16,1%). Diabetes is a bit less common (12,6%), pts after myocardial infarction, cerebral insults (5.6%) and TIA (3,9%). Trombembolism risk calculating with CHA2DS2- VASc scale 38 (7,8%) pts had one point and 447 (92,2%) ≥ 2 points. The mean number of points is 3,8. A one month after ECV the following cardiovascular episodes were present: ACS (0,9%), CHF decompensated (0,4%), PATE/DVT (0,4%), AF relapses (20,5%). During three months ACS (0,5%) were documented, ADHF/ HCF decompensation (0,5%), PATE/DVT (0.5%) and AF relapses (26,3%). Six months after ECV 0,7% of pts had ACS, 2% had CHF decompensation, 0,7% had PATE/DVT, 1,4% had strokes and 36.4% had AF relapses. The occurence of bleeding depending of control time for varfarine was starting from 4,62% (p=0,013) to 6,62% (p=0,067), for aspirine from 3,13% (p=0,119) to 3,31 (p=0.067). The occurence of any bleeding during one and three month of control for dabigatran 1,2% and for rivaroxaban 0.9%.

Conclusion: The occurence of cardiovascular risks is similar with the data in other papers, except for AH and CHF, which is higher in this study. The occurence of cardiovascular epizodes in this study was less often, but the risk of clinical episodes by CHA2DS2-VASc scale is higher than in other studies. Using novel oral anticoagulants according to the guidelines before and after ECV is more safer with varfarine during the first month and in longer periods of time