Efficacy and Safety of Apixaban in Patients Following Cardioversion for Atrial Fibrillation: Insights from the ARISTOTLE trial.
ABSTRACT To determine the risk of major clinical and thromboembolic events after cardioversion for atrial fibrillation in subjects treated with apixaban, an oral factor Xa inhibitor compared with warfarin.
In patients with atrial fibrillation (AF), thromboembolic events may occur after cardioversion. This risk is lowered with vitamin K antagonists and dabigatran.
Using data from ARISTOTLE, we conducted a post-hoc analysis of patients undergoing cardioversion.
A total of 743 cardioversions in 540 patients were performed: 265 first cardioversions in patients assigned to apixaban and 275 in those receiving warfarin. The mean time to the first cardioversion for patients assigned to warfarin and apixaban was 243 + 231 and 251 + 248 days respectively; 75% of the cardioversions occurred by 1 year. Baseline characteristics were similar between groups. In patients undergoing cardioversion, no stroke or systemic emboli occurred in the 30 day follow-up period. MI occurred in 1 patient (0.2%) receiving warfarin and 1 receiving apixaban (0.3%). Major bleeding occurred in 1 patient (0.2%) receiving warfarin and 1 receiving apixaban (0.3%). Death occurred in 2 patients (0.5%) receiving warfarin and 2 patients receiving apixaban (0.6%).
Major cardiovascular events after cardioversion of AF are rare and comparable between warfarin and apixaban.
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ABSTRACT: Electrical cardioversion (ECV) is recommended for rhythm control in patients with atrial arrhythmia; yet, ECV use and outcomes in contemporary practice are unknown. We reviewed all nonemergent ECVs for atrial arrhythmias at a tertiary care center (2010 to 2013), stratifying patients by transesophageal echocardiography (TEE) use before ECV and comparing demographics, history, vitals, and laboratory studies. Outcomes included postprocedural success and complications and repeat cardioversion, rehospitalization, and death within 30 days. Overall, 1,017 patients underwent ECV, 760 (75%) for atrial fibrillation and 240 (24%) for atrial flutter; 633 underwent TEE before ECV and 384 did not. TEE recipients were more likely to be inpatients (74% vs 44%, p <0.001), have higher mean CHADS2 scores (2.6 vs 2.4, p = 0.03), and lower mean international normalized ratios (1.2 vs 2.1, p <0.001). Overall, 89 patients (8.8%) did not achieve sinus rhythm and 14 experienced procedural complications (1.4%). Within 30 days, 80 patients (7.9%) underwent repeat ECV, 113 (11%) were rehospitalized, and 14 (1.4%) died. Although ECV success was more common in patients who underwent TEE before ECV (77% vs 68%, p = 0.01), there were no differences in 30-day death or rehospitalization rates (11.1% vs 13.0%, p = 0.37). In multivariate analyses, higher pre-ECV heart rate was associated with increased rehospitalization or death (adjusted hazard ratio 1.15/10 beats/min, 95% confidence interval 1.07 to 1.24, p <0.001), whereas TEE use was associated with lower rates (adjusted hazard ratio 0.58, 95% confidence interval 0.39 to 0.86, p = 0.007). In conclusion, failures, complications, and rehospitalization after nonemergent ECV are common and associated more with patient condition than procedural characteristics. TEE use was associated with better clinical outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.The American Journal of Cardiology 02/2015; 115(10). DOI:10.1016/j.amjcard.2015.02.030 · 3.43 Impact Factor
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ABSTRACT: Atrial fibrillation is the most common form of cardiac arrhythmia, occurring in 1-2 % of the population and due to an increased life expectancy the prevalence will increase further. Pharmacological treatment of atrial fibrillation is an important component of basic initial therapeutic options for patients with atrial fibrillation. Independent of an individually adjusted prevention of thromboembolism, rate and rhythm management can also be carried out. While rate control mainly applies to all patients, rhythm control is only indicated in patients who remain clinically symptomatic despite sufficient rate control. Profound knowledge about antiarrhythmic drugs including specific interactions is necessary due to the variable individual effects and sometimes severe side effects.Herz 02/2015; DOI:10.1007/s00059-014-4201-3 · 0.91 Impact Factor
- Archives of Cardiovascular Diseases 01/2015; 108(2). DOI:10.1016/j.acvd.2014.12.001 · 1.66 Impact Factor