Department of Cardiology, Medical Center Hungarian Defence Forces, 44 Robert Karoly Krt., 1134 Budapest, Hungary.
Heart and Vascular Center, Semmelweis University, 68 Varosmajor u., 1122 Budapest, Hungary.
Eur Heart J Cardiovasc Pharmacother. 2017 Jul 1;3(3):147-150. doi: 10.1093/ehjcvp/pvx003.
In patients with atrial fibrillation (AF) pharmacological or electrical cardioversion may be performed to restore sinus rhythm. The procedure is associated with an increased risk of thromboembolic events, which can be significantly reduced by adequate anticoagulation (OAC). Our aim was to create a partly prospective, partly retrospective cardioversion registry, particularly focusing on OAC strategies in different European countries, and on emerging choice of OAC over time.
From September 2014 to October 2015, cardioversions due to AF performed in six European city hospitals in five European countries (Hungary: Budapest-1 and -2; Italy: Bari and Pisa; France: Amiens; Spain: Madrid; and Lithuania: Kaunas) were recorded in the registry.
A total of 1101 patients (retrospective/prospective: 679/422, male/female: 742/359, mean age: 67.3 years ± 11.2) were registered. Most of the cardioversions were electrical (97%). Oral anticoagulants were administered in 87% of the patient, the usage of non-VKA oral anticoagulants (NOACs) vs Vitamin K antagonists (VKA) was 31.5% vs 68.5%, respectively. Seventy seven percent of the patients were given oral anticoagulants more than 3 weeks prior to the procedure, and 86% more than 4 weeks after the procedure. When using VKA, international normalized ratio (INR) at cardioversion was above 2.0 in 76% of the cases. A decline in VKA usage (P = 0.033) in elective cardioversion over approximately 1 year was observed. During the observation period, there was an increase in apixaban (P < 0.001), a slight increase in rivaroxaban (P = 0.028) and no changes in dabigatran (P = 0.34) usage for elective cardioversion. There were differences in use of OAC between the countries: Spain used most VKA (89%), while France used least VKA (39%, P < 0.001).
According to current AF guidelines, NOACs are adequate alternatives to VKA for thromboembolic prevention in AF patients undergoing elective cardioversion. Our results indicate that NOAC use is increasing and there is a significant decrease in VKA use.
在心房颤动（AF）患者中，可进行药物或电复律以恢复窦性节律。该操作与血栓栓塞事件的风险增加相关，通过适当的抗凝治疗（OAC）可显著降低这种风险。我们的目的是创建一个部分前瞻性、部分回顾性的复律登记处，特别关注不同欧洲国家的 OAC 策略，以及随着时间的推移 OAC 选择的变化。
从 2014 年 9 月至 2015 年 10 月，在五个欧洲国家的六个欧洲城市医院（匈牙利：布达佩斯-1 和 -2；意大利：巴里和比萨；法国：亚眠；西班牙：马德里；立陶宛：考纳斯）进行的 AF 所致电复律被记录在该登记处。
共登记了 1101 例患者（回顾性/前瞻性：679/422；男/女：742/359；平均年龄：67.3 岁±11.2 岁）。大多数复律为电复律（97%）。87%的患者接受了口服抗凝治疗，非维生素 K 拮抗剂（NOAC）与维生素 K 拮抗剂（VKA）的使用率分别为 31.5%和 68.5%。77%的患者在手术前 3 周以上开始接受口服抗凝治疗，86%的患者在手术后 4 周以上开始接受口服抗凝治疗。当使用 VKA 时，76%的病例复律时国际标准化比值（INR）超过 2.0。在大约 1 年的时间里，我们观察到择期电复律中 VKA 的使用有所减少（P=0.033）。在观察期间，阿哌沙班的使用率有所增加（P<0.001），利伐沙班的使用率略有增加（P=0.028），达比加群的使用率没有变化（P=0.34）。不同国家的 OAC 使用存在差异：西班牙使用的 VKA 最多（89%），而法国使用的 VKA 最少（39%，P<0.001）。
根据目前的 AF 指南，NOAC 是 AF 患者择期电复律中预防血栓栓塞的合适替代药物。我们的结果表明，NOAC 的使用正在增加，而 VKA 的使用显著减少。
