Poor maintenance of sinus rhythm after electrical cardioversion of patients with atrial fibrillation or flutter: a 5-year follow-up of 268 consecutive patients.

Objective - To report long- term results of direct current ( DC)- cardioversion in unselected patients with atrial fibrillation ( AF) or flutter. Design - The study was a retrospective 5- year followup of all patients undergoing DC- cardioversion for AF or flutter at our institution between 1993 and 1997. Results - Three hundred and eighty- five DC- cardioversions were performed in 268 patients. Two hundred and forty- nine patients underwent cardioversion for the first time. Of these, 183 ( 74%) were converted to sinus rhythm. During the first month of follow- up 105 ( 57%) relapsed into AF. Only 33 patients ( 13%) of the 249 patients scheduled for cardioversion remained in sinus rhythm after 1 year. In multivariate analysis arrhythmia duration was the only variable that was associated with successful cardioversion. Periprocedural complications occurred in 9.9% of the cardioversions. Conclusion - In daily routine only a minority of patients will maintain sinus rhythm after DC- cardioversion for AF or flutter. Also, DC- cardioversion is not without risk. These observational data suggest a conservative approach to re- establishment of sinus rhythm in patients with AF.