{
  "abstract": "Background Maintenance of SR (sinus rhythm) after ECV (electrical cardioversion) for AF remains challenging. Studies have shown that patients with impaired left ventricular (LV) function have poorer chances of SR maintenance post ECV. Better understanding of the role certain HF therapies play in patients with impaired LV function undergoing ECV is vital to enable better allocation of resources and provision of a more integrated community cardiology service, from which these patients can gain from.Methods A single centre retrospective study was conducted at a district hospital to assess outcomes of patients with persistent AF/A.Flutter undergoing elective ECV, with varying degrees of LV dysfunction. LV dysfunction was categorised based on the EF (Ejection fraction %) from the most recent pre-procedural TTE (trans-thoracic echocardiogram) and clinical records. Patients aged ≥18years, with persistent AF/A.flutter, with recent pre-procedural TTE, who underwent an ECV (January 2019-January 2024) and were followed up 6–8 weeks post ECV (with an ECG to assess whether SR was maintained) were included.Results Of 176 patients who underwent an ECV during the study period, 50 had EF<40% and 38 had an EF ≥40%-<50%.The proportion who were under HF nurse follow up was 58% and 18.4% respectively. The association between regular community HF nurse follow-up and maintenance of SR post ECV was not significant in each heart failure cohort {EF<40% :Fisher’s exact test p=0.139,χ 2 p=0.79} {EF ≥40% <50% : Fisher’s exact test p= 0.203, χ2 p= 0.099}. However this association was significant in the cohort of patients with prior diagnosis of ‘CCF’ on clinical records {n= 24,Binary logistic regression p=0.009, Fishers exact test p=0.011,χ2 p= 0.005}.Additionally, in patients with EF<40% and EF<50%, there was a significant association between them being on HF prognostic medications and chances of SR maintenance post ECV { χ2p<0.001 and 0.038}. Regarding specific HF prognostic medications, MRA (mineralocorticoid receptor antagonist) use was significantly associated with increased chances of SR maintenance in both cohorts {Binary logistic regression p=0.005 and 0.026}, whereas use of Beta blockers, ACE-I (Angiotensin-converting enzyme inhibitors), Sodium-glucose co-transporter-2 (SGLT2) inhibitors, Sacubitril/valsartan in either cohort of patients was not.Conclusion Despite a relatively modest sample size, our findings suggest patients with appropriately managed HF have improved chances of SR maintenance than patients with poorly managed HF. Further similar studies with a larger cohort are recommended to reaffirm our findings. Our results can be applied in the community to ensure these patients are provided more regular community HF nurse follow up, allowing optimisation of their HF prognostic medication and augment their HF status. This has the potential to reduce the burden of repeat ECV procedures, and tertiary care referrals for AF ablation.",
  "authors": [
    {
      "affiliations": [
        "Colchester General Hospital, Colchester, UK"
      ],
      "name": "Humaiyun Sabih"
    },
    {
      "affiliations": [
        "Colchester General Hospital, Colchester, UK"
      ],
      "name": "Mohamed Shkeban"
    }
  ],
  "title": "4-024 Evaluating the impact of HF(heart failure) therapy in patients with AF(atrial fibrillation)/A.flutter(atrial flutter) and LV dysfunction, undergoing ECY (electrical cardioversion)",
  "uid": "a441cfe8-800d-5de8-b014-606c375e4be8"
}