This is an early access version
,
Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
,
Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
,
Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
,
Department of Clinical Pharmacology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
,
Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
,
Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
,
Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
,
Department of Pediatrics, General Hospital "Prim. Dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
,
Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
,
Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
,
University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
,
University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
,
University of Zenica, Zenica, Bosnia and Herzegovina
Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
Department of Neurosurgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
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.
No specific funding was received for this study.
Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. 
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.