{
  "abstract": "Introduction Studies showed that obstructive sleep apnea (OSA) is associated with an increased prevalence of supraventricular arrhythmia e.g. atrial fibrillation (AF) and atrial flutter (AFl). Such finding was attributed to the higher occurrence of other cardiovascular comorbidities in OSA patients, such as hypertension, heart failure and coronary artery disease (CAD). 1 Currently, there is no evidence of the effect of OSA on the outcomes of direct current cardioversion (DCCV) and the number of shocks the patient receives during the procedure. It was also not evident whether the effects of OSA on DCCV outcomes were due to associated comorbidities.Methods We conducted a cross-sectional study of 193 patients diagnosed with AF and AFl and treated with DCCV at a general district hospital between November 2020 and March 2023. Data collected included age, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), thyroid disorders, OSA, significant valvular disease, left ventricular ejection fraction (LVEF) <40%, left atrial dilatation, and AF duration. Multivariate logistic regression was used to assess factors associated with DCCV failure, and correlation analysis was conducted to determine factors influencing the number of shocks.Results The mean age of the studied population was 66.5 years. Among the studied cohort, OSA was the only factor significantly associated with an increased failure rate of DCCV ( table 1). In patients with OSA, the failure rate of DCCV was significantly higher compared to those without OSA (p=0.005). Moreover, a positive correlation was observed between OSA and the number of shocks required during the procedure (Point biserial correlation coefficient, r=0.2, p=0.006) (figure 1). The multivariate logistic regression model revealed that OSA was independently associated with an increased risk of DCCV failure, with a hazard ratio of 10.5 (95% CI 2.5–53.5, p=0.005).Abstract 4-011 Table 1Association of different characteristics with failure of DCCV Parameters Prevalence P of association with failed DCCV 1- Hypertension 48.7% 0.512 2- Diabetes 15% 0.1 3- Thyroid disease 7.3% 0.28 4- COPD 5.2% 0.73 5- Valvular disease 26.4% 0.9 6- CAD 16.1% 0.35 7- OSA 7.3% 0.001 8- LA dilatation 72% 0.96 9- LVEF<40% 16.6% 0.61 Abstract 4-011 Figure 1Correlation between OSA and number of received shocksConclusions Obstructive sleep apnoea is an independent predictor of failure in DCCV of AF and AFl. It is positively correlated with the number of shocks delivered during the procedure. These findings suggest that clinicians should consider screening for OSA in patients undergoing DCCV for AF or AFl, as its presence may help identify individuals at higher risk for procedural failure and higher shock requirements. Further studies are needed to explore the mechanisms underlying this association and whether addressing OSA can improve DCCV outcomes.Reference Wolk R, Kara T, Somers VK: Sleep-disordered breathing and cardiovascular disease. Circulation 2003;108:9–12. 10.1161/01.CIR.0000072346.56728.E4/ASSET/124BC704–8A52–4820-B7F8–7F027B3339CA/ASSETS/GRAPHIC/10FF3.JPEG",
  "authors": [
    {
      "affiliations": [
        "Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"
      ],
      "name": "Amr Elkammash"
    },
    {
      "affiliations": [
        "Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"
      ],
      "name": "Ke Wei Foong"
    },
    {
      "affiliations": [
        "Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"
      ],
      "name": "Daniel Mckenzie"
    }
  ],
  "title": "4-011 Predictors of DCCV failure and the number of shocks in atrial fibrillation and flutter: a cross-sectional study in a district hospital",
  "uid": "26df7dcb-1f2c-56d4-bd9a-8bdc2936f7ed"
}