Comparison of efficacy of pharmacological and electrical cardioversion and predictors of early arrhythmia recurrence in patients with persistent and long-standing persistent atrial fibrillation

Objective . To compare the efficacy of pharmacological cardioversion with cavutilide and electrical cardioversion in patients with persistent and long-standing persistent atrial fibrillation (AF), and to identify predictors of early arrhythmia recurrence. Design and methods . The study included 104 patients with persistent or long-standing persistent atrial fibrillation who underwent pharmacological (cavutilide) or electrical cardioversion. Prospective follow-up was conducted for 1 week. Results . The groups of patients undergoing electrical or pharmacological cardioversion were comparable by baseline clinical and echocardiographic parameters. The efficacy of pharmacological cardioversion with cavutilide was comparable to that of electrical cardioversion (50/59 (84,7 %) vs. 41/45 (91,1 %), p = 0,331). Predictors of failure to restore sinus rhythm included: duration of the current episode of persistent AF and prior cardioversion. The rate of early arrhythmia recurrence in the pharmacological and electrical cardioversion groups was comparable (17/50 (34 %) vs. 11/41 (26,8 %), p = 0,461). Patients with early AF recurrence demonstrated more pronounced enlargement of the left and right atria. The most significant predictor of early AF recurrence was a higher left atrial volume index (LAVI), with a ROC analysis-derived threshold value of 50,5 mL/m², associated with the 2,34‑fold increase in the risk of arrhythmia recurrence. Conclusion . The efficacy of pharmacological cardioversion with cavutilide is comparable to that of electrical cardioversion. Predictors of failure to restore sinus rhythm include the duration of the current AF episode and prior cardioversion. Left atrial volume index exceeding 50,5 mL/m² is associated with the 2,34‑fold increase in the risk of arrhythmia recurrence within 1 week after cardioversion.