Heart with electrical currents, symbolizing atrial fibrillation and cardioversion.

Decoding Atrial Fibrillation: Can a Failed Cardioversion Predict Future Heart Rhythm Problems?

Rhea Morgan in Health & Wellness November 2025 • 4 min read.

"New research reveals that unsuccessful electrical cardioversion for early atrial arrhythmia recurrence could signal a higher risk of future episodes. Learn what this means for your heart health."

Atrial fibrillation (AFib) is a common heart condition characterized by an irregular heartbeat, which can increase your risk of stroke, heart failure, and other complications. Catheter ablation is a procedure often used to treat AFib, aiming to restore a normal heart rhythm. After the procedure, many patients experience what’s known as early recurrence of atrial arrhythmia (ERAA), which occurs within the first 90 days, also known as the blanking period.

ERAA doesn't always mean the ablation has failed. It is often attributed to temporary inflammation of the heart tissue caused by the procedure. Because of this, doctors typically avoid performing another ablation during this period, and instead might use medications or electrical cardioversion (ECV) to manage these early recurrences.

Electrical cardioversion involves delivering a controlled electrical shock to the heart to reset its rhythm. Whether or not this cardioversion is successful in the short term, may hold clues about long term outcomes. A recent study has shed light on the significance of failed ECV for ERAA, suggesting it could be a predictor of future AFib recurrence.

The Link Between Failed Cardioversion and Future Recurrence

Heart with electrical currents, symbolizing atrial fibrillation and cardioversion.

The study, published in The American Journal of Cardiology, investigated whether a failed ECV during the blanking period was associated with a higher risk of AFib recurrence after catheter ablation. Researchers followed 1,240 patients who underwent first-time catheter ablation for AFib, and focused on the 517 patients (42%) who experienced ERAA. Of these, 262 patients underwent ECV.

The success of ECV was determined by whether the procedure terminated AFib and maintained a normal heart rhythm for at least 30 seconds after the shock. The study divided patients into two groups: Failed-ECV group: Those who experienced at least one failed ECV but eventually had a successful ECV later on. Successful-ECV group: Those who experienced only successful ECVs.

Failed-ECV group: Experienced at least one failed ECV.
Successful-ECV group: Experienced only successful ECVs.

The results showed that during a median follow-up of 610 days, the recurrence rate was significantly higher in the failed-ECV group (76.2%) compared to the successful-ECV group (45.6%). After adjusting for other factors, failed ECV was identified as an independent predictor of AFib recurrence.

What This Means For You

If you’ve undergone catheter ablation for AFib and experienced ERAA requiring electrical cardioversion, it’s important to discuss these findings with your cardiologist. While a failed ECV doesn't guarantee future AFib, it does suggest a higher risk. This knowledge can empower you and your doctor to make informed decisions about your ongoing care, including closer monitoring, lifestyle adjustments, and potentially more aggressive treatment strategies.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.amjcard.2018.11.039, Alternate LINK

Title: Usefulness Of Failed Electrical Cardioversion For Early Recurrence After Catheter Ablation For Atrial Fibrillation As A Predictor Of Future Recurrence

Subject: Cardiology and Cardiovascular Medicine

Journal: The American Journal of Cardiology

Publisher: Elsevier BV

Authors: Ryo Nakamaru, Nobuaki Tanaka, Masato Okada, Koji Tanaka, Yuichi Ninomiya, Yuko Hirao, Takafumi Oka, Hiroyuki Inoue, Yasushi Koyama, Atsunori Okamura, Katsuomi Iwakura, Hiromi Rakugi, Yasushi Sakata, Kenshi Fujii, Koichi Inoue

Published: 2019-03-01

Everything You Need To Know

What is atrial fibrillation (AFib) and why is it a concern?

Atrial fibrillation, or AFib, is a common heart condition characterized by an irregular heartbeat. This irregular rhythm can elevate the risk of serious complications such as stroke and heart failure. Managing AFib effectively, therefore, is crucial for overall heart health and reducing the likelihood of these adverse outcomes.

What does 'early recurrence of atrial arrhythmia' (ERAA) mean in the context of atrial fibrillation treatment?

Early recurrence of atrial arrhythmia, known as ERAA, refers to the return of irregular heartbeats within the first 90 days following a catheter ablation procedure for AFib. This initial period is often called the blanking period. ERAA is not always indicative of a failed ablation but can be related to temporary inflammation of the heart tissue resulting from the procedure.

What is electrical cardioversion (ECV), and how is its success determined?

Electrical cardioversion, or ECV, is a medical procedure used to restore a normal heart rhythm in individuals experiencing atrial fibrillation or other arrhythmias. It involves delivering a controlled electrical shock to the heart, which helps to reset its electrical activity and revert it to a regular rhythm. The success of an ECV is determined by its ability to terminate the AFib and maintain a normal heart rhythm for at least 30 seconds after the shock.

How does a failed electrical cardioversion during early atrial arrhythmia recurrence relate to future AFib episodes?

Research indicates that a failed electrical cardioversion during an early recurrence of atrial arrhythmia (ERAA) might be an indicator of future atrial fibrillation recurrence. Individuals who experienced a failed ECV during the blanking period after a catheter ablation showed a higher rate of AFib recurrence compared to those with successful ECVs. This suggests that the response to ECV during ERAA can provide valuable prognostic information.

If I've had catheter ablation and experienced early recurrence treated with electrical cardioversion, what should I discuss with my cardiologist?

If you have undergone catheter ablation for AFib and experienced early recurrence of atrial arrhythmia requiring electrical cardioversion, it's important to have an in-depth discussion with your cardiologist. While a failed ECV doesn't definitively mean future AFib, it suggests a potentially elevated risk. Based on the study findings, you and your doctor can make informed decisions regarding your ongoing care, considering closer monitoring, lifestyle adjustments, and potentially more aggressive treatment strategies to manage your heart rhythm effectively. Additional diagnostic evaluations might be needed to see if the initial catheter ablation was successful.