Is electrical cardioversion independently associated with infarcts on brain magnetic resonance imaging or clinical outcomes in patients with atrial fibrillation?

Annina Stauber; Andreas Müller; Nikki Rommers; Stefanie Aeschbacher; Leo H Bonati; David Conen; Tobias Reichlin; Peter Ammann; Nicolas Rodondi; Marcello DiValentino; Giorgio Moschovitis; Helena Aebersold; Jürg Hans Beer; Tim Sinnecker; Raban V Jeger; David J Kurz; Claudia Liedtke; Michael Kühne; Stefan Osswald; Alain M Bernheim; Swiss-AF investigators

doi:10.1016/j.hrthm.2024.06.026

Is electrical cardioversion independently associated with infarcts on brain magnetic resonance imaging or clinical outcomes in patients with atrial fibrillation?

Heart Rhythm. 2024 Jul 19:S1547-5271(24)02739-5. doi: 10.1016/j.hrthm.2024.06.026. Online ahead of print.

Authors

Annina Stauber¹, Andreas Müller¹, Nikki Rommers², Stefanie Aeschbacher³, Leo H Bonati⁴, David Conen⁵, Tobias Reichlin⁶, Peter Ammann⁷, Nicolas Rodondi⁸, Marcello DiValentino⁹, Giorgio Moschovitis¹⁰, Helena Aebersold¹¹, Jürg Hans Beer¹², Tim Sinnecker¹³, Raban V Jeger¹, David J Kurz¹, Claudia Liedtke¹, Michael Kühne¹⁴, Stefan Osswald¹⁴, Alain M Bernheim¹⁵; Swiss-AF investigators

Affiliations

¹ Department of Cardiology, Stadtspital Zurich Triemli, Zurich, Switzerland.
² Department of Clinical Research, University of Basel, Basel, Switzerland.
³ Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
⁴ Division of Neurology and Stroke Centre, Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Department of Research, Rehabilitation Clinic Rheinfelden, Rheinfelden, Switzerland.
⁵ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
⁶ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁷ Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland.
⁸ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁹ Department of Cardiology, Ospedale San Giovanni, Bellinzona, Switzerland.
¹⁰ Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland.
¹¹ Department of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.
¹² Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital Zurich, Zurich, Switzerland.
¹³ Division of Neurology and Stroke Centre, Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
¹⁴ Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland; Division of Cardiology, Department of Medicine, University of Basel, Basel, Switzerland.
¹⁵ Department of Cardiology, Stadtspital Zurich Triemli, Zurich, Switzerland. Electronic address: [email protected].

PMID: 39177518
DOI: 10.1016/j.hrthm.2024.06.026

Abstract

Background: Electrical cardioversion (ECV) is frequently performed in symptomatic atrial fibrillation.

Objective: This study aimed to assess the association of ECV with infarcts on brain magnetic resonance imaging (bMRI) and clinical outcomes.

Methods: The Swiss Atrial Fibrillation Cohort Study included 2386 patients; 1731 patients were evaluated by bMRI. ECVs were recorded by questionnaire. Patients were assigned to categories by number of ECVs performed before enrollment (0, 1, ≥2). A bMRI study was conducted at baseline and after 2 years (n = 1227) and analyzed for large noncortical or cortical infarcts and small noncortical infarcts. Clinical outcomes were recorded during follow-up. Associations of ECV and outcome measures were assessed by multivariate analyses.

Results: There was no independent association between the number of ECVs and infarct prevalence (large noncortical or cortical infarcts and small noncortical infarcts) on baseline bMRI (ECV 1 vs 0: odds ratio [OR], 0.95 [95% CI, 0.68-1.24]; ECV ≥2 vs 0: OR, 1.04 [0.72-1.44]) or between ECVs performed during follow-up and new infarcts on bMRI at 2 years (OR, 1.46 [0.54-3.31]). ECVs were not associated with overt stroke or transient ischemic attack (ECV 1 vs 0: hazard ratio [HR], 1.36 [0.88-2.10]; ECV ≥2 vs 0: HR, 1.53 [0.94-2.48]), hospitalization for heart failure (ECV 1 vs 0: HR, 1.06 [0.82-1.37]; ECV ≥2 vs 0: HR, 1.03 [0.77-1.38]), or death (ECV 1 vs 0: HR, 0.90 [0.70-1.15]; ECV ≥2 vs 0: HR, 0.91 [0.69-1.20]).

Conclusion: There was no association between ECV performed before enrollment and cerebral infarcts on baseline bMRI or between ECV performed during follow-up and new infarcts at 2 years. Moreover, ECV was not associated with clinical events.

Keywords: Atrial fibrillation; Cerebral infarcts; Clinical outcomes; Electrical cardioversion; Magnetic resonance imaging.