{
    "abstract": "Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post-DCCV in rural Australia.\nThe primary aim was to determine the preferred AAD post-DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR.\nA retrospective observational audit of patients with non-valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015-2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12\u2009months post-DCCV.\n233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post-DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12\u2009months post-DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p\u2009=\u20090.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices.\nThe study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12\u2009months post-DCCV. Prescribing practices post-DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting.",
    "authors": [
        {
            "affiliation": "Department of Cardiology, Dubbo Base Hospital, Dubbo, New South Wales, Australia.\nDepartment of Intensive Care Medicine, Westmead Hospital, Westmead, New South Wales, Australia.",
            "firstname": "Martin",
            "initials": "M",
            "lastname": "Thomas"
        },
        {
            "affiliation": "Research and Education Network, Western Sydney Local Health District, Westmead, New South Wales, Australia.",
            "firstname": "James",
            "initials": "J",
            "lastname": "Elhindi"
        },
        {
            "affiliation": "Department of Cardiology, Dubbo Base Hospital, Dubbo, New South Wales, Australia.",
            "firstname": "Kanishka",
            "initials": "K",
            "lastname": "Kamaladasa"
        },
        {
            "affiliation": "Department of Cardiology, Dubbo Base Hospital, Dubbo, New South Wales, Australia.",
            "firstname": "Tilak",
            "initials": "T",
            "lastname": "Sirisena"
        }
    ],
    "conclusions": "The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12\u2009months post-DCCV. Prescribing practices post-DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting.",
    "copyrights": "\u00a9 2024 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.",
    "doi": "10.1111/ajr.13138",
    "journal": "The Australian journal of rural health",
    "keywords": [
        "cardiovascular medicine",
        "clinical practice",
        "outcomes",
        "rural health",
        "safety and quality"
    ],
    "methods": null,
    "publication_date": "2024-05-20",
    "pubmed_id": "38766693",
    "results": "233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post-DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12\u2009months post-DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p\u2009=\u20090.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices.",
    "title": "Antiarrhythmic preferences and outcomes post DC cardioversion for atrial fibrillation, an Australian rural perspective.",
    "xml": "<Element 'PubmedArticle' at 0x788503066160>"
}