Risk Factors Associated with Decompensated Heart Failure Following Successful Cardioversion of Atrial Fibrillation and Atrial Flutter: A Validation Cohort.

BACKGROUND: Risk factors for the development of decompensated heart failure (HF) with persistence of sinus rhythm within 30 days of successful CV of AF/AFL remain unclear. OBJECTIVES: This study aims to validate the previously identified incidence and risk factors for the development of heart failure following successful cardioversion (CV) of atrial fibrillation (AF) and atrial flutter (AFL) using a larger patient cohort. METHODS: Patients who underwent electrical or catheter ablation based CV at the University of Wisconsin Hospitals between 7/1/2020-12/31/2022 were analyzed for development of HF within 30 days of successful CV. Exclusion criteria included patients who presented for CV in a rhythm other than AF/AFL, recurrence of AF/AFL within 30 days of CV, alternative etiology for HF identified, and those with no clinical encounters post-operatively. RESULTS: Of the 765 patients included, 31 (4.05%) experienced HF symptoms within 30 days of CV. A multivariate stepwise logistic regression model revealed BMI≥40 (OR 6.98 95% CI 2.01, 24.21) and prior HF hospitalization (OR 2.52 95% CI 1.09, 5.79) were significant risk factors for developing HF post CV. Prior AAD use in males was a significant risk factor for the development of 30-day HF. The duration of AF and ejection fraction (EF) were not statistically significant risk factors for 30-day HF. CONCLUSIONS: Decompensated HF following successful CV of AFL/AF occurred in 4.05% of patients. BMI≥40 and prior HF hospitalization remained significant predictors of 30-day HF post CV.