Sex, age, and time to cardioversion. Risk factors for cardioversion of acute atrial fibrillation from the FinCV study.

BACKGROUND: Female sex, old age, and time to cardioversion increase the risk of thromboembolic complications (TEC) after cardioversion of atrial fibrillation (AF) < 48 h. The interaction of these variables is not known. We investigated the interaction of sex, age, and time to electrical cardioversion (ECV) on TEC in anticoagulant-naive patients with acute AF.

METHODS AND RESULTS: The primary outcome was a TEC within 30 days following ECV. Patients were divided into three age groups and time to cardioversion into <12 h and ≥12 h in 4715 ECVs. TEC occurred in 40 (0.8%) patients. In multivariate analysis, female sex, time to ECV, and vascular disease were independent predictors of TEC. For patients ≤75 cardioverted within 12 h, the incidence of TEC was low. In patients >75 TEC increased in both sexes and particularly in women (1.4% vs. 0.9%, p = 0.03). When ECVs exceeded 12 h, the risk of TEC was two- to four-fold higher in women in all age groups.

CONCLUSIONS: The risk of TEC increases substantially in patients >75 and ECVs ≥12 h, particularly in women. Time to cardioversion should be added to risk-stratification of ECVs of acute AF. Key messages The ideal timing of cardioversion is still unknown and not based on solid evidence. Delay to cardioversion ≥12 h should be added to the risk stratification of atrial fibrillation cardioversion. Female sex increases the risk of complications and failure of cardioversion after electrical cardioversion of atrial fibrillation <48 h, especially with age >75 years and time to cardioversion exceeding 12 h.