Cardioversion of atrial fibrillation and its effect on right ventricular function as assessed by tricuspid annular motion
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Ventricular Function
Normal Sinus Rhythm
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Atrial fibrillation (AF) in dogs can be managed by electrical cardioversion to sinus rhythm, but early recurrence of AF occurs in some dogs. In humans, the commonly evaluated clinical variables for prediction of early relapse of AF are left atrial size and duration of AF. It is unclear whether the duration of AF affects maintenance of sinus rhythm after cardioversion in dogs with spontaneous AF.That duration of sinus rhythm after cardioversion is related to the chronicity of AF.Forty-one consecutive dogs that had undergone successful transthoracic cardioversion for spontaneous AF were evaluated.The relationship between the duration of documented AF and the duration of sinus rhythm after cardioversion was statistically evaluated using data obtained retrospectively. The effects of structural heart disease and pretreatment with amiodarone were also evaluated.The presence of structural heart disease and the duration of documented AF had significant effects on maintenance of sinus rhythm after cardioversion (P <.001 and P=.022, respectively). The duration of documented AF was inversely related to the duration of sinus rhythm (P=.022) in dogs with and without structural heart disease.Estimates of duration of sinus rhythm based on the duration of documented AF are provided for dogs with and without heart disease allowing prediction of risk for early AF relapse.
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Electrical cardioversion
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To assess factors related to the success of restoration and one-year maintenance of sinus rhythm in chronic (more than 48 h) nonrheumatic atrial fibrillation (AF).One hundred and fifty consecutive patients aged 62+/-9 years with AF lasting 123+/-254 days were evaluated clinically with transthoracic and transesophageal echocardiography before elective direct current cardioversion. Heart chamber dimensions and left ventricular ejection fraction were measured. The presence of left atrial thrombi and spontaneous echocardiographic contrast as well as flow velocities in the left atrial appendage were assessed. The first cardioversion was followed by standardized two-step antiarrhythmic treatment including a second cardioversion, if necessary. Twenty patients (13%) spontaneously reverted to sinus rhythm (S) during anticoagulation preceding cardioversion, 81 (54%) were successfully cardioverted (Y), and in 49 (33%) cardioversion failed initially (N). No differences were noted between the two latter groups. However, S patients had smaller left atria measured in the short and long axes (42+/-4 mm, P=0.05, and 53+/-7 mm, P=0.005, respectively) than both the Y (45+/-4 and 61+/-8 mm) and the N patients (46+/-4 and 61+/-8 mm). One-year follow-up was obtained in 95 patients: 64 (67%) were in sinus rhythm while 31 (33%) had AF. Again, no initial differences predicting the maintenance of sinus rhythm were found.Spontaneous reversion of AF seems more likely with smaller left atria. Echocardiography, including trans-esophageal echocardiography, is unlikely to identify patients in whom attempts to restore and maintain sinus rhythm will fail or succeed.
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The predictive value of plasma atrial natriuretic peptide (ANP) on the cardioversion outcome was evaluated in 46 hospitalized patients with recent-onset atrial fibrillation (AF). Cardioversion was successful in 42 (91%) patients, 7 (15%) of them regained sinus rhythm spontaneously. After 12 months, 14 (33%) cardioverted patients were in chronic AF. There were no differences in plasma ANP levels between groups where cardioversion failed, those who cardioverted but later developed chronic AF or those who remained in sinus rhythm. However, among patients who were on antiarrhythmic therapy, ANP levels obtained after cardioversion were lower in those who later remained in sinus rhythm. We conclude that lower ANP after cardioversion may be associated with increased chances of long-term preservation of sinus rhythm.
Atrial natriuretic peptide
Electrical cardioversion
Normal Sinus Rhythm
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AIM To assess relationships between the BNP(plasma brain natriuretic peptide) levels and the risk for thromboembolism,successful cardioversion and maintenance of sinus rhythm in patients with lone atrial fibrillation(AF).METHODS Plasma BNP levels were measured and TEE(transesophageal echocardiography) and CT/MRI were performed in 103 consecutive patients with lone AF.Fifteen patients with a history of thromboembolism or echocardiographic evidence of thrombus were compared with 88 AF patients without complications.Sixteen AF patients with failed cardioversion or recurrence of AF were compared with seven patients with successful cardioversion and maintenance of sinus rhythm.RESULTS The patients with thromboembolism had higher plasma BNP levels than the patients without thromboembolism [(150±43) ng/L vs(84±40)ng/L,P0.05].The patients of failed cardioversion had higher plasma BNP levels,longer duration of AF and greater left atrial diameter(LAD) than the patients of successful cardioversion [(178±70)ng/L versus(60±32)ng/L,(8±3)m versus(3±2)m,(49±5)mm versus(42±3) mm,respectively.All P0.05].Overall analysis of the continuous variables with multiple logistic regression analysis revealed that BNP was a significant predictor of thromboembolism(P0.05).BNP,LAD and history of AF were independent predictors of failed cardioversion and the recurrence of AF(all P0.05).CONCLUSION BNP levels can be used as a useful noninvasive measure to detect patients at high risk thromboembolism and select the patients who should undergo cardioversion for lone AF.
Brain natriuretic peptide
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Inflammation has been recently implicated in the pathophysiology of atrial fibrillation (AF). The aim of this study was to examine the variation of inflammatory indexes during the first week after successful electrical cardioversion of persistent AF. Successive measurements of white blood cell (WBC) count, C-reactive protein (CRP) and fibrinogen levels were performed in 30 cardioverted patients. At the end of the 7-day follow-up period, AF had recurred in 30% of patients. A significant variance was found in serial measurements of fibrinogen levels in the two groups (non-relapse and relapse, p = 0.005). Fibrinogen levels increased significantly in patients who relapsed into AF, but remained stable in patients who remained in sinus rhythm. In the latter patients, CRP values tended to decrease post-cardioversion, but WBC count was significantly lower (p < 0.001) on the 7th day (6083 ± 1335), compared with baseline values (6648 ± 1395). The variation of inflammatory indices post-cardioversion might have prognostic implications with regard to sinus rhythm maintenance.
White blood cell
Electrical cardioversion
Pathophysiology
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Electrical cardioversion
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