Letters to the Editor Atrial stunning as predictor of early relapse into atrial fibrillation after cardioversion
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Although the high rate of success after cardioversion, less than 50% of patients maintain sinus rhythm for the first year. In view for the high percentage of relapse into atrial fibrillation, it is interesting to analyze the relationship between atrial stunning after cardioversion and relapse into atrial fibrillation. Thus, we evaluated 101 patients with atrial fibrillation and successful cardioversion. Atrial mechanical function was assessed by measures of transmitral peak A wave velocity, determined before and weekly after cardioversion during 1 month. Fifty-five percent of patient relapse into atrial fibrillation during follow-up. No significant differences were found in clinical and echocardiographic variables between the group with and without relapse. However, the group of patients who relapsed into atrial fibrillation showed a lower peak A wave velocity immediately after cardioversion than patients who maintain in sinus rhythm at month (0.44 T0.27 vs. 0.60 T0.38 m/s p<0.01). Impaired atrial function improves during the first 14 days after cardioversion. D 2005 Elsevier Ireland Ltd. All rights reserved.Keywords:
P wave
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Objective To evaluate if self-limited episodes of atrial fibrillation after direct current(DC) cardioversion predict re- currence of persistent atrial fibrillation. Methods Consecutive patients with persistent atrial fibrillation, scheduled for DC cardiover- sion were prospectively included in the study. Ambulatory ECG Hoher monitoring (24 h) was performed one, three and 6 weeks after successful cardioversion. Results A total of 80 patients were prospectively included in the study. Sinus rhythm was restored in 73 pa- tients (88%). At 6 weeks of follow -up 40 patients out of 73 (54%) had sinus thythm, and 33 patients (46%) had relapsed into per- sistent atrial frbrillation. Eight out of these 34 patients (24%) had bursts of atrial fibrillation at their first Holter recording, compared to 12 patients out of 40 (30%) in sinus rhythm at 6 weeks (P > 0.05). On the first, second and third Holter recording 21 patients out of 51 (41%), 22 patients out of 43 (51%) and 15 out of 40 patients (38%) had self - limited bursts of atrial fibrillation,respeetively. Condusion In patients successfully converted to sinus rhythm self- limited bursts of atrial fibrillation do not predict recurrence of persistent atrial fibrillation during 6 weeks of follow up. Brief self- limited episodes of atrial fibrillation are common, and the incidence and duration of such episodes are constant during a 6 weeks period after DC cardioversion.
Key words:
Arrhythmia; Atrial fibrillation; Cardioversion
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Supine position
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Stunning
Myocardial Stunning
Electrical cardioversion
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We studied cardiac rhythm in 167 patients with mitral stenosis following open mitral commissurotomy in the last 7 years. After surgery 76 patients (72%) out of 106 patients who presented atrial fibrillation before surgery were reverted back to sinus rhythm by D-C cardioversion. Forty-three patients (41%) maintained sinus rhythm at the time of discharge from hospital, and 30 patients (28%) maintained it for 2.5 years (average) after surgery. The actuarial maintenance rate of sinus rhythm was 50 + 11% 7 years after surgery in these 43 patients. Ninety-three% of the 30 patients who reverted to and maintained sinus rhythm improved to class I (New York Heart Association criteria), whereas 47% of the 78 patients who retained atrial fibrillation remained in class II or III after surgery. In 30 patients who reverted back to sinus rhythm and maintained it late postoperatively, the preoperative duration of atrial fibrillation was up to 5 years, and 35% of the patients had had atrial fibrillation for more than 1 year. Also, in 40% of these 30 patients, the preoperative cardiothoracic ratio was more than 60%. Therefore, in the patients who reverted to atrial fibrillation immediately after surgery, secondary D-C cardioversion should be performed under stable hemodynamic conditions 10 to 14 days after surgery, even if their preoperative duration of atrial fibrillation was more than 1 year or their preoperative cardiothoracic ratio was more than 60%.
Cardiothoracic surgery
Commissurotomy
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Our aim was to determine the immediate and long-term outcome of direct current (DC) electrical cardioversion in patients with atrial fibrillation or flutter, and to determine factors predicting clinical outcome.A retrospective one-year follow-up study of 220 patients with atrial fibrillation or flutter undergoing electrical cardioversion between September 1998 and April 2001 was done.Electrical cardioversion was successful in 82% of the patients. Multivariate analysis revealed that female gender was associated with successful cardioversion (p=0.008). Only 29% remained in sinus rhythm after the one-year follow-up. Maintenance of sinus rhythm was associated with anti-arrhythmic drug treatment (p=0.042). Relapse of atrial fibrillation was associated with reduced left ventricular ejection fraction (p=0.002). Complications occurred in 7.7% of the electrical cardioversions; of these, 1.2% were thromboembolic events.Less than one third of the patients remained in sinus rhythm after the one-year follow-up despite the use of anti-arrhythmic drugs. Electrical cardioversion is not without risk. Thorough consideration of choice of treatment in patients with atrial fibrillation or flutter is therefore important. According to Danish and international guidelines, electrical cardioversion should be considered primarily when symptoms of AF are unacceptable despite optimal frequency regulation or in patients with AF detected for the first time.
Electrical cardioversion
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Can We Predict the Failure of Electrical Cardioversion of Acute Atrial Fibrillation? The FinCV Study
Background Data on predictors of failure of electrical cardioversion of acute atrial fibrillation are scarce. Methods We explored 6,906 electrical cardioversions of acute (<48 hours) atrial fibrillation in 2,868 patients in a retrospective multicenter study. Results The success rate of electrical cardioversion was 94.2%. In 26% of unsuccessful cardioversions, the cardioversion was performed successfully later. Antiarrhythmic drug therapy, short (<12 hours) duration of atrial fibrillation episode, advanced age, permanent pacemaker, history of atrial fibrillation episodes within 30 days before cardioversion, and β‐blockers were independent predictors of unsuccessful electrical cardioversion. In the subgroup of patients with cardioversion of the first atrial fibrillation episode (N = 1,411), the short duration of episode (odds ratio [OR] = 2.28; 95% confidence interval [CI] 1.34–3.90, P = 0.003) and advanced age (OR = 1.03; 95% CI 1.02–1.05, P < 0.001) were the only independent predictors of unsuccessful cardioversion. After successful cardioversion, the rate of early (<30 days) clinical recurrence of atrial fibrillation was 17.3%. The index cardioversion being performed due to the first atrial fibrillation episode was the only predictor of remaining in the sinus rhythm. Conclusion A short (<12 hours) duration of acute atrial fibrillation is a significant predictor of unsuccessful cardioversion, especially during the first attack. First atrial fibrillation episode was the only predictor of remaining in the sinus rhythm.
Electrical cardioversion
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AIM To analyze factors after successful direct-current cardioversion in patients with atrial fibrillation and to explore late recurrences of the arrhythmia. METHODS Forty-three patients with atrial fibrillation without associated valvular heart disease, who underwent non-emergent cardioversion within the years 2002-2006, were included. We retrospectively analyzed clinical data from the medical records. Late reccurence of the arrhythmia was defined as arrhythmia in patients discharged with sinus rhythm. RESULTS Median follow-up of the patients was 33 (17, 48) months. We found 20 late recurrences of atrial fibrillation in the total group of 43 patients after successful direct-current cardioversion (46.5%). In a 6-month period after direct-current cardioversion the recurrence of arrhythmia was found in two patients, in a one-year period in 6 patients and in a period longer than one year in 12 patients. Median time to recurrence was 15 (6, 33) months. Females relapsed more frequently than males (p < 0.02), what could be explained by higher age, incidence of hypertension and thyreopathy in females. Patients with a history of thyropathy had more frequent occurrence of arrhythmia, despite normal values of TSH, as compared to patients without a history of thyropathy (p < 0.04). Patients with recurrence of the atrial fibrillation had higher systolic pressure (130 vs 120 mm Hg, p < 0.05) and pulse arterial pressure (50 vs 40 mm Hg, p < 0.01) after cardioversion. No significant difference between the two groups in age, left atrium diameter, left ventricle ejection fraction and cardiovascular, or non-cardiovascular risk factors was found. CONCLUSION Despite successful direct-current cardioversion, the risk of late recurrence of the atrial fibrillation in a following period is at least 46.5%. Females, patients with a history of thyropathy and those with higher systolic and pulse arterial pressures are at higher risk of late recurrences.
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P wave
Electrical cardioversion
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Objective: To clinically investigate the optimal opportunity of electric cardioversion for atrial fibrillation after PVMV in patients with rheumatic heart disease mitral stenosis.Methods :164 patients with rheumatic heart disease mitral stenosis complicating atrial and suit for PBMV were prospectively surveyed and divided into 3 groups based on the diameter of left atrium and the time of electric cardioversion.The diameter of left atrium ≤50mm and time for cardioversion ≤1 month(group A);the diameter of left atrium ≤50mm and time for cardioversion 3～6 month(group B);the diameter of left atrium 50mm and time for cardioversion 3～6 month.ratio of success for electric cardioversion,ratio of maintaining sinus rhythm,capacity for cardioversion 、shock times and complication are recorded.Results:Ratio of success group A 93.02%,group B 100%,group C 91.3%.ratio of success for group A is significantly different compared to group C(p0.05) and no different compared to group C(p0.05).ratio of success for group B is greatly different compared to group C(p0.01).maintenance rate of sinus rhythm for cardioversion about half a year later,group A 85% group B 96% and group C 85.71%.maintenance rate for group A has greatly difference compared to group B(p0.01) and no difference compared to group C(p0.05).according to capacity of cardioversion and shock times,group A has no difference compared to group C(p0.05).group A and group B have greatly difference compared to group C(p0.05).Conclusion:It is safe and operative for patients with rheumatic mitral stenosis and atrial fibrillation which are suited for PBMV.The time for cardioversion is suitable about 3～6 months after PBMV in order to increase ratio of success 、maintain sinus rhythm 、reduce capacity、shock times and complication.
Group B
Electrical cardioversion
Atrium (architecture)
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The aim of this study is to analysis the relationship of clinical variables to the recurrence of atiral fibrillation after cardioversion to optimize the indication for rhythm control. Retrospective study analysed medical records of the atrial fibrillation patients who have undergone cardioversion from 2000 to 2002. The univariate and multivariate associations of immediate efficacy of cardioversion and long-term results with clinical variables were analyzed. Results: 386 patients who had undergone pharmacological cardioversion or electrical cardioversion were enrolled. Almost half of the patients relapsed within 1 week after successful cardioversion. At the end of one year follow-up, 135 patients (35%) recovered from atrial fibrillation. There were no significant difference between the recurrence group and unrecurrence group in age, heart disease and the methodology of cardioversion. The predictors for the recurrence of atrial fibrillation were diameter of the left atrium ≥50mm(OR=1.86, 95%CI 1.02-3.69, P=0.0472),pre-cardioversion duration ≥7 days (OR=2.08, 95%CI 1.19-3.65, P= 0.01) and the duration of atrial fibrillation (OR=1.77, 95%CI 1.01-3.06, P= 0.0456). Conclusions:The enlargement of left atrium and long duration of atrial fibrillation before cardioversion show less successful rate and more recurrence in the future
Univariate analysis
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