Arrhythmias & electrophysiology
Long-term risk of cardiovascular implantable electronic device reinterventions following external cardioversion of atrial fibrillation and flutter: A nationwide cohort study
Authors' conclusion
ECV in patients with a CIED is associated with a higher risk of generator replacement and lead reintervention. The risks of reinterventions were more pronounced within the first year after cardioversion.
Study context
- Population
- Patients with a CIED (pacemaker, implantable cardioverter-defibrillator (ICD), CRT-P or CRT-D) undergoing external cardioversion (ECV) for AF or flutter, Danish nationwide registries
- Participants
- 2,582 vs 12,910
- Exposure
- ECV-exposed vs matched CIED generators/leads without ECV
- ECV-exposedn = 2,582
- Matchedn = 12,910reference
- Outcome
- Generator replacement and lead reintervention
- Follow-up
- 2 years
Methodological detailsnationwide, matched, registry-based
- Nationwide
- Matched
- Registry-based
Main finding
As reported in the abstract
2 years
ECV-exposed
- Generator replacement
- 210 (8.1%)
- Lead reintervention
- 247 (5.6%)
Matched
- Generator replacement
- 670 (5.2%)
- Lead reintervention
- 306 (2.3%)
Generator replacement
ECV-exposed210 (8.1%)
Matched670 (5.2%)
Lead reintervention
ECV-exposed247 (5.6%)
Matched306 (2.3%)
ECV-exposed vs MatchedHazard ratio (95% CI)P value
Generator replacement, unadjusted
1.61(1.37–1.91)
P < 0.001Lead reintervention, unadjusted
2.39(2.01–2.85)
P < 0.001Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Generator replacement and lead reintervention, relative risks · 1 year and 2 yearsECV-exposedvs Matched1-year, generator replacement | 1.73 (1.41–2.12) | P < 0.001 | |
| Generator replacement and lead reintervention, relative risks · 1 year and 2 yearsECV-exposedvs Matched1-year, lead reintervention | 2.85 (2.32–3.51) | P < 0.001 | |
| Generator replacement and lead reintervention, relative risks · 1 year and 2 yearsECV-exposedvs Matched2-year, generator replacement | 1.39 (1.19–1.63) | P < 0.001 | |
| Generator replacement and lead reintervention, relative risks · 1 year and 2 yearsECV-exposedvs Matched2-year, lead reintervention | 2.18 (1.84–2.57) | P < 0.001 | |
| 0.20.5125Relative risk (log scale) |
Original publication
Long-term risk of cardiovascular implantable electronic device reinterventions following external cardioversion of atrial fibrillation and flutter: A nationwide cohort study. Heart Rhythm. Published 23 March 2023. doi:10.
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