Chapter 2 24 3. Results 3.1 Patient population and cardioversion A total 1570 elective ECV procedures were scheduled in the study period. In 94 cases (6.0%) no ECV was performed and 45 cases (2.9%) had insufficient follow-up after an ECV (Fig. 1). Preprocedural TEE was performed in 23 patients (1.5%) and a left atrial thrombus was suspected in 5 cases resulting in postponement of the procedure (Appendix A). Final analysis was performed in the remaining 1431 ECV procedures among 920 patients. Almost two-third of the patients received one ECV procedure during the study period (n=610), while the remaining one-third received ≥2 ECV procedures (n=310). These 310 patients with multiple ECV procedures had a total of 511 repeat ECV procedures. Repeat ECV procedures were performed more often in the VKA group in comparison to the DOAC group (39% versus 28%, P<0.001). The reason for a repeat ECV was recurrence of atrial tachyarrhythmia (n=450, 88%) or a prior not successful ECV (n=61, 12%), this was similar for both groups. Periprocedural DOAC was used in 488 (34%) procedures, while in the remainder of the procedures (n=943, 66%) periprocedural VKA was used. Of the 488 cardioversions performed on DOAC, dabigatran was used in 225 of 488 procedures (46%); apixaban in 114 procedures (23%); rivaroxaban in 81 procedures (17%); and edoxaban in 68 procedures (14%). Periprocedural VKAs used were acenocoumarol (n=846) or phenprocoumon (n=97). The use of DOAC increased steadily over the years during the study period, increasing from 5% in 2013 to 73% in 2020 (Fig. 2). Since 2018, DOAC was used in more than half of the procedures. There were differences in baseline characteristics between the VKA and DOAC group (Table 1). The VKA group comprised a more complex patient population with a higher proportion of patients with congenital heart disease, congestive heart failure, coronary heart disease, diabetes mellitus, LV dysfunction and renal insufficiency. This is also reflected by a higher proportion of patients with a HAS-BLED bleeding score ≥3 and American Society of Anaesthesiologists (ASA) physical status classification system score ≥3. However, the thromboembolic risk as reflected by the mean CHA2DS2-VASc score was similar between groups. The acute cardioversion success was similar between groups (92% for both groups, P=0.70).
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