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

Risk factors for the development of decompensated heart failure (HF) with persistence of sinus rhythm within 30 days of successful cardioversion (CV) of atrial fibrillation (AF)/ atrial flutter (AFL) remain unclear. This study aims to validate the previously identified incidence and risk factors for the development of HF following successful CV of AF and AFL using a larger patient cohort. 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 postoperatively. Of the 765 patients included, 31 (4.05%) experienced HF symptoms within 30 days of CV. A multivariate stepwise logistic regression model revealed body mass index (BMI) ≥40 (OR 6.98, 95% CI 2.01, 24.21) and previous HF hospitalization (OR 2.52, 95% CI 1.09, 5.79) were significant risk factors for developing HF post-CV. Previous 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. Decompensated HF following successful CV of AFL/AF occurred in 4.05% of patients. BMI ≥40 and previous HF hospitalization remained significant predictors of 30-day HF post-CV.