Elective cardioversion at a district general hospital: a retrospective evaluation of outcomes

Atrial fibrillation (AF) poses a significant challenge to patients, physicians and healthcare systems globally. AF is the most prevalent arrhythmia in clinical practice, with an estimated global prevalence of 46.3 million (Choi and Kwon, 2022). It is more common in males than females, with ageing, ethnicity and genetics all factors affecting likelihood of AF (Hindricks et al, 2021). AF progression is associated with a decline in quality of life, which in time becomes irreversible and less amenable to treatment, consequently leading to a requirement for further interventions including pacemakers, costly heart failure treatment and a significant burden on the healthcare system.

Cardioversion is a rhythm control therapy that is recommended in symptomatic patients with persistent AF (Hindricks et al, 2021) to improve symptoms and quality of life (QoL). Indications for elective cardioversion are symptom management of AF, improving heart failure symptoms (tachycardia-mediated cardiomyopathy) and an intervention for failed pharmacological cardioversion. Boodhoo et al (2004) suggested that direct current cardioversion is the most effective method for restoring sinus rhythm in patients with persistent AF. It has been reported that cardioversion successfully terminates AF in 90% of cases (Brandes et al, 2020).