Spontaneous conversion in patients with non-valvular atrial fibrillation planned for electrical cardioversion: a subanalysis of the ENSURE-AF trial

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Authors

  • Ariel Cohen
  • Hein Heidbuchel
  • Jean-Yves Le Heuzey
  • Raffaele De Caterina
  • Jose L. Merino
  • James Jin
  • Michael Melino
  • Shannon M. Winters
  • Andreas Goette

Colleges, School and Institutes

Abstract

We investigated the characteristics of patients who underwent spontaneous conversion before scheduled cardioversion in the ENSURE-AF study, a prospective randomized clinical trial of anticoagulation in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The study demonstrated similar efficacy and safety of the oral factor Xa inhibitor edoxaban versus enoxaparin–warfarin. Spontaneous conversion occurred in 7.6% of patients, and was associated with a history of paroxysmal atrial fibrillation but not with thromboembolic or bleeding events.

Strategies for urgent restoration of sinus rhythm in patients presenting with atrial fibrillation (AF) include heart-rate control, immediate direct-current cardioversion, and pharmacological cardioversion.1 However, cardioversion is associated with periprocedural thromboembolic events. Furthermore, AF symptoms can resolve spontaneously within 24 hours in many patients with new-onset AF.2., 3., 4.

Rates of spontaneous conversion range from 50%4 to 71%3 in recent-onset AF, and shorter duration of symptoms is a significant predictor of spontaneous conversion.5., 6. The ability to identify patients with a high probability of spontaneous conversion is important, and could be used in the decision to postpone cardioversion and avoid the risks associated with the procedure.

EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion Of Atrial Fibrillation (ENSURE-AF) is the largest prospective randomized clinical trial of anticoagulation in patients undergoing electrical cardioversion of non-valvular AF; the study demonstrated similar efficacy and safety of the oral factor Xa inhibitor edoxaban versus enoxaparin–warfarin.7 We performed an ancillary analysis using the ENSURE-AF data to determine the incidence of spontaneous conversion. Our aim was, first, to compare the data from patients with spontaneous conversion to those with non-spontaneous conversion; second, to describe the characteristics and outcomes of patients with spontaneous conversion; and third, to identify independent predictors of spontaneous conversion, to more accurately identify patients who are likely to undergo spontaneous conversion to sinus rhythm.

Details

Original languageEnglish
JournalAmerican Heart Journal
Early online date22 Nov 2018
Publication statusE-pub ahead of print - 22 Nov 2018