Atrial Fibrillation Recurrence Prevention after Electrical Cardioversion in High-Risk Patients – Benefits of Non-Antiarrhythmic Drugs

Baiba Kokina1, *, Oskars Kalejs2, 3, Aija Maca2, 3, Aldis Strelnieks2, 4, Kristine Jubele2, 3, Irina Rudaka3, 5, 6, Ketija Apsite3, 5, Aivars Lejnieks2, 7
1 Faculty of Medicine, Riga Stradins University, Riga, Latvia
2 Department of Internal Diseases, Riga Stradins University, Riga, Latvia
3 Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
4 Department of Cardiology, Riga East Clinical University Hospital, Riga, Latvia
5 Faculty of Residency, Riga Stradins University, Riga, Latvia
6 Scientific Laboratory of Molecular Genetics, Riga Stradins University, Riga, Latvia
7 Department of Endocrinology, Riga East Clinical University Hospital, Riga, Latvia

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Creative Commons License
© 2021 Kokina et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Faculty of Medicine, Riga Stradins University, Riga, Latvia; E-mail: bkokina@inbox.lv



Recurrence prevention after Atrial Fibrillation (AF) termination by Eelectrical Cardioversion (ECV) remains challenging. Increasing attention is paid to pathophysiological effects of non-Antiarrhythmic Drugs (non-AADs), nevertheless, with heterogeneous results.


We evaluated the potential benefits of different non-AADs as adjunctive therapy to Antiarrhythmic Drugs (AADs) for AF recurrence prevention after sinus rhythm restoration by ECV in high-risk patients.


The study was conducted among high-risk AF patients after successful ECV. Prescription of class IC or class III AAD was required. Data were acquired in a face-to-face baseline interview and 1-, 3-, 6-, 9-, 12-month follow-up interviews.


113 patients were included. Total AF recurrence rate reached 48.7%. Angiotensin-Converting Enzyme Inhibitor (ACEI) or angiotensin receptor blocker (ARB) intake, compared with non-use, demonstrated AF recurrence rate reduction by 8.5% (46.3 vs. 54.8%), with odds ratio (OR) reduced by 28.9% (OR 0.711, 95% confidence interval (CI) 0.310-1.631, p = 0.420). Among mineralocorticoid receptor antagonist (MRA) users, AF recurrence rate was reduced by 25.1% (29.6 vs. 54.7%) and OR by 65.1% (OR 0.349, 95%CI 0.138-0.884, p = 0.023). Present statin therapy reduced AF recurrence rate by 4.2% (46.8 vs. 51.0%) and OR by 15.5% (OR 0.845, 95%CI 0.402-1.774, p = 0.656). Diuretic use showed reduction of AF recurrence rate by 10.2% (41.7 vs. 51.9%) and OR by 33.9% (OR 0.661, 95%CI 0.297-1.469, p = 0.308).


Non-AADs demonstrated practical benefits as adjunctive therapy to AADs for AF recurrence prevention after ECV in high-risk patients, with statistically significant results established for concomitant MRA intake.

Keywords: Atrial fibrillation, Electrical cardioversion, Arrhythmia recurrence, Non-antiarrhythmic medications, Mineralocorticoid receptor antagonists, Diuretics.