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Original article

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Approaches to rhythm control: Impact of electrical cardioversion versus pharmacological management on left atrial size and systolic performance in atrial fibrillation and flutter

By
Emir Bećirović Orcid logo ,
Emir Bećirović
Contact Emir Bećirović

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Minela Bećirović Orcid logo ,
Minela Bećirović

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Amir Bećirović Orcid logo ,
Amir Bećirović

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Lejla Tupković Rakovac Orcid logo ,
Lejla Tupković Rakovac

Department of Clinical Pharmacology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Amira Jagodić Ejubović Orcid logo ,
Amira Jagodić Ejubović

Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Begajeta Čaušević Orcid logo ,
Begajeta Čaušević

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Malik Ejubović Orcid logo ,
Malik Ejubović

Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Aida Ribić Orcid logo ,
Aida Ribić

Department of Pediatrics, General Hospital "Prim. Dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina

Lamija Ferhatbegović Orcid logo ,
Lamija Ferhatbegović

Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Ammar Brkić Orcid logo ,
Ammar Brkić

Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Semir Hadžić Orcid logo ,
Semir Hadžić

University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Maida Skokić Orcid logo ,
Maida Skokić

University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Emir Begagić Orcid logo
Emir Begagić

University of Zenica, Zenica, Bosnia and Herzegovina

Editor: SELMA UZUNOVIĆ

Abstract

Aim To compare the impact of electrical cardioversion (ECV) and pharmacological cardioversion (PCV) on left atrial size (LA) and left ventricular ejection fraction (LVEF), as well as to identify predictors of rhythm disorder recurrence in patients with atrial fibrillation (AF) or atrial flutter (AFL).
Methods A prospective observational cohort study was conducted on 105 patients with persistent AF or AFL at the University Clinical Centre Tuzla. The patients were divided into two groups: 53 underwent ECV and 52 received PCV. Demographic and clinical data, including ECG and transthoracic echocardiography, were collected. Follow-up assessments were conducted at 7 days, 1 month, and subsequently every 3 months for a year.
Results Baseline characteristics were similar between the groups. Recurrence of rhythm disorder within one year was observed in 52.4% of cases, with ECV showing a slightly lower, though not significantly different, primary failure rate at 7 days compared to PCV (13.2% vs. 23.1%). Significant predictors of recurrence included longer duration of disorder (p<0.001), hypertension (p=0.016), lack of pre-cardioversion amiodarone (p=0.027), and larger LA (p<0.001). Both ECV and PCV significantly reduced LA over time, with no significant differences in LVEF between groups.
Conclusion Both ECV and PCV are effective in restoring sinus rhythm, with a trend towards lower recurrence in the ECV group. Predictors such as disorder duration, hypertension, lack of pre-cardioversion amiodarone, and LA should be considered when planning cardioversion to optimize patient outcomes.

Author Contributions

Conceptualization, E.B. and M.B.; Funding acquisition, E.B.; Investigation, E.B.; Project administration, E.B.; Writing – original draft, E.B.; Writing – review & editing, M.B. and A.J.E.; Methodology, A.B.; Validation, L.T.R., B.Č. and S.H.; Supervision, M.E.; Visualization, A.R.; Formal Analysis, L.F.; Resources, A.B.; Data curation, M.S.; Software, E.B. All authors have read and agreed to the published version of the manuscript.

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Funding Statement

No specific funding was received for this study.

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

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