Clinical Characteristics of Patients With Persistent Atrial Fibrillation Referred for Cardioversion: Spanish Cardioversion Registry (REVERSE)

The objectives were to investigate the treatment and clinical characteristics of patients referred for cardioversion in Spain and to compare them with those reported in the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) and RACE (RAte Control versus Electrical cardioversion) studies. The prospective study involved 1515 consecutive patients with persistent atrial fibrillation who were referred for cardioversion at 96 Spanish hospitals. Half of the patients were being treated with Vaughan-Williams group I or III antiarrhythmic drugs. The most frequently used approach to anticoagulation was to administer dicoumarins 3–4 weeks before and after cardioversion. Our patients were younger than those in the AFFIRM and RACE studies. Compared with AFFIRM patients, our patients had a lower prevalence of previous embolism, ischemic heart disease, hypertension, diabetes, and systolic dysfunction. Compared with RACE patients, our patients had a lower prevalence of ischemic heart disease and previous embolism, but a slightly higher prevalence of hypertension and diabetes. We conclude that patients referred for cardioversion in Spain clearly had a lower cardiovascular risk profile than those in the AFFIRM study, and appeared to have a lower risk profile than those in the RACE study.

Los objetivos fueron conocer el manejo y las características clínicas de los pacientes remitidos a cardioversión en España y compararlos con los de los estudios AFFIRM y RACE. Se registró prospectiva y consecutivamente a 1.515 pacientes con fibrilación auricular persistente remitidos a cardioversión en 96 hospitales españoles. La mitad recibía tratamiento con antiarrítmicos de los grupos I o III de Vaughan-Williams. La estrategia de anticoagulación con dicumarínicos 3–4 semanas antes y después de la cardioversión fue la más utilizada. Nuestros pacientes eran más jóvenes que los de AFFIRM y RACE. Respecto al AFFIRM, tenían menor prevalencia de embolias previas, cardiopatía isquémica, hipertensión, diabetes y disfunción sistólica. Respecto al RACE, tenían menor prevalencia de cardiopatía isquémica y embolias previas, pero algo mayor de hipertensión y diabetes. Concluimos que los pacientes remitidos a cardioversión en España tienen un perfil de menor riesgo cardiovascular que los del AFFIRM y aparentemente menor que los del RACE.