{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T11:39:25Z","timestamp":1777721965575,"version":"3.51.4"},"reference-count":12,"publisher":"IMR Press","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background: Recurrence of atrial fibrillation (AF) and atrial flutter (AFL) after direct current cardioversion (DCCV) remains a common problem. Several predictors of recurrence have been identified in observational studies. Current guidelines recommend considering amiodarone as an adjunct in patients at high risk of AF\/AFL recurrence. However, data in the available literature on the effectiveness of amiodarone in restoring and maintaining sinus rhythm (SR) are sparse. Methods: This observational cross-sectional study analysed retrospective data from 193 patients who underwent elective DCCV for AF\/AFL at a single UK cardiac centre, with follow-up at 6 weeks and 12 months. Baseline patient characteristics, including demographic data, echocardiographic findings, co-morbidities, and SR maintenance rate, were compared between patients treated with amiodarone and those without. Multivariate logistic regression was performed to identify parameters associated with DCCV failure. Results: A total of 13.0% of the study population were started on amiodarone before DCCV. Those on amiodarone were more likely to have had a previous failed DCCV (60.0% vs. 21.4%; p &lt; 0.001), AF\/AFL duration of at least 12 months (84.0% vs. 53.0%; p = 0.003), a left ventricular ejection fraction (LVEF) of less than 40% (32.0% vs. 14.3%; p = 0.03), and a diagnosis of coronary artery disease (CAD) (32.0% vs. 13.7%; p = 0.02). Treatment with amiodarone was not associated with an increased rate of SR restoration at the time of DCCV (96.0% vs. 92.3%; p = 0.50). However, amiodarone treatment was associated with SR maintenance at 6 weeks (92.0% vs. 54.8%; p &lt; 0.001) and at 12 months (60.0% vs. 26.8%; p &lt; 0.001). Multivariate logistic regression analysis identified obstructive sleep apnoea (OSA) as the only parameter associated with DCCV failure (adjusted odds ratio (OR) 10.5; 95% confidence interval (CI) 2.5\u201353.5; p = 0.005). There was an increased risk of peri-procedural bradyarrhythmia with amiodarone therapy (adjusted OR 8.85; 95% CI 1.84\u201342.7; p = 0.007). Conclusions: Amiodarone treatment is associated with maintenance of SR following elective DCCV for AF\/AFL. This effect is observed even in patients with risk factors for recurrence, including previous failed DCCV, longer AF\/AFL duration, and reduced LVEF. OSA is an independent predictor of DCCV failure; further research is required to delineate the role of early adjunctive amiodarone therapy in these patients.<\/jats:p>","DOI":"10.31083\/rcm47485","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:31:56Z","timestamp":1777458716000},"source":"Crossref","is-referenced-by-count":0,"title":["When Sleep and Rhythm Collide: Amiodarone, Obstructive Sleep Apnoea, and Sinus Rhythm Maintenance After Cardioversion"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4994-2936","authenticated-orcid":true,"given":"Ke Wei","family":"Foong","sequence":"first","affiliation":[{"name":"Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, BA1 3NG Bath, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9322-3347","authenticated-orcid":true,"given":"Amr","family":"Elkammash","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, BA1 3NG Bath, UK"},{"name":"School of Translational Health Sciences, University of Bristol, BS8 1QU Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2242-0474","authenticated-orcid":true,"given":"Daniel","family":"McKenzie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, BA1 3NG Bath, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref1","unstructured":"Nesheiwat Z, Goyal A, Jagtap M, Shammas A. Atrial Fibrillation. StatPearls: Treasure Island (FL). 2023."},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Demirel O, Berezin AE, Mirna M, Boxhammer E, Gharibeh SX, Hoppe UC, et al. Biomarkers of Atrial Fibrillation Recurrence in Patients with Paroxysmal or Persistent Atrial Fibrillation Following External Direct Current Electrical Cardioversion. Biomedicines. 2023; 11: 1452.","DOI":"10.3390\/biomedicines11051452"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Um KJ, McIntyre WF, Mendoza PA, Ibrahim O, Nguyen ST, Lin SH, et al. Pre-treatment with antiarrhythmic drugs for elective electrical cardioversion of atrial fibrillation: a systematic review and network meta-analysis. 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Journal of the American College of Cardiology. 2003; 41: 249\u2013254.","DOI":"10.1016\/s0735-1097(02)02709-2"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Shantha G, Pelosi F, Morady F. Relationship Between Obstructive Sleep Apnoea and AF. Arrhythmia & Electrophysiology Review. 2019; 8: 180\u2013183.","DOI":"10.15420\/aer.2019.35.2"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Antoun I, Layton GR, Abdelrazik A, Eldesouky M, Altoukhy S, Zakkar M, et al. Predicting the Outcomes of External Direct Current Cardioversion for Atrial Fibrillation: A Narrative Review of Current Evidence. Journal of Cardiovascular Development and Disease. 2025; 12: 168.","DOI":"10.3390\/jcdd12050168"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Darrat Y, Leung S, Elayi L, Parrott K, Ogunbayo G, Kotter J, et al. A stepwise external cardioversion protocol for atrial fibrillation to maximize acute success rate. 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Amiodarone Therapy: Updated Practical Insights. Journal of Clinical Medicine. 2024; 13: 6094.","DOI":"10.3390\/jcm13206094"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Saleeb-Mousa J, Nathanael D, Coney AM, Kalla M, Brain KL, Holmes AP. Mechanisms of Atrial Fibrillation in Obstructive Sleep Apnoea. Cells. 2023; 12: 1661.","DOI":"10.3390\/cells12121661"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Linz D, McEvoy RD, Cowie MR, Somers VK, Nattel S, L\u00e9vy P, et al. Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review. JAMA Cardiology. 2018; 3: 532\u2013540.","DOI":"10.1001\/jamacardio.2018.0095"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/4\/10.31083\/RCM47485","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:33:38Z","timestamp":1777458818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/4\/10.31083\/RCM47485"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":12,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1530-6550(26)02573-0"],"URL":"https:\/\/doi.org\/10.31083\/rcm47485","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]},"article-number":"47485"}}