Atrial fibrillatory rate and sinus rhythm maintenance in patients undergoing cardioversion of persistent atrial fibrillation

Holmqvist, Fredrik; Stridh, Martin; Waktare, Johan; Sörnmo, Leif; Olsson, S. Bertil; Meurling, Carl

doi:10.1093/eurheartj/ehl098

Cited by 63 publications

(62 citation statements)

References 36 publications

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Section: Indices Of Electrical Remodeling and Sr Maintenancementioning

confidence: 83%

“…[1], [5], [6] and [22] However, as in earlier observations from our group studying AFR as an index of atrial remodeling, the overlap between patients maintaining SR and those not maintaining SR is extended. 5 In the present study, the performance of AFSE and AFR was virtually identical. Previous studies have shown slightly better performance of AFSE when discriminating paroxysmal from persistent AF [2] and [6] and predicting SR maintenance following cardioversion.…”

Section: Indices Of Electrical Remodeling and Sr Maintenancementioning

confidence: 83%

“…The impact of amiodarone on AFSE has, to the best of our knowledge, not been described, but antiarrhythmic treatment has in a previous study been shown to alter the predictive properties of AFR in a similar patient population. 5 Finally, the AFSE was estimated using the 10-second ECG recording in the study by Alcaraz and Rieta, whereas in the present study, recordings of 5-minute lengths were used. The possible impact of this, if any, is not known.…”

Section: Indices Of Electrical Remodeling and Sr Maintenancementioning

confidence: 99%

“…A high AFR is a risk factor of AF relapse following electrical cardioversion, but foremost reliable in patients with a short history of AF. 5 In a preliminary report, AF signal entropy (AFSE), that is, the degree of atrial signal irregularity, was shown to discriminate paroxysmal from persistent AF. Persistent AF was associated with higher entropy values than paroxysmal, suggesting a more disorganized atrial activity among patients with persistent AF.…”

Section: Introductionmentioning

confidence: 99%

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Noninvasive estimation of organization in atrial fibrillation as a predictor of sinus rhythm maintenance

Petersson

Sandberg

Platonov

et al. 2011

Journal of Electrocardiology

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Previous studies indicate that the predictive value of atrial fibrillatory rate in patients undergoing cardioversion of atrial fibrillation (AF) of long duration is limited. The present study investigates signal entropy in this setting. Standard 12-lead electrocardiograms (ECGs) were recorded from 66 consecutive patients with AF undergoing cardioversion and sample entropy estimated. Patients were followed for 4 weeks. At follow-up, 59% of the patients had relapsed to AF. The AF signal entropy of these patients before cardioversion was 0.099 ± 0.015, whereas it was 0.093 ± 0.012 among the 41% maintaining sinus rhythm (P = .02). As hypothesized, signal entropy was lower in patients who maintained sinus rhythm 4 weeks after cardioversion than in those who did not. However, the overlap was large, making its clinical value limited.

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Section: Indices Of Electrical Remodeling and Sr Maintenancementioning

confidence: 83%

Section: Indices Of Electrical Remodeling and Sr Maintenancementioning

confidence: 83%

Section: Indices Of Electrical Remodeling and Sr Maintenancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Noninvasive estimation of organization in atrial fibrillation as a predictor of sinus rhythm maintenance

Petersson

Sandberg

Platonov

et al. 2011

Journal of Electrocardiology

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“…for the prediction of electrical cardioversion outcome for AF. However, very different and, consequently, inconclusive results have been obtained [10]. Thereby, the aim of this work is to obtain a new robust and non-invasive predictor of NSR maintenance after ECV before it is attempted.…”

Section: Introductionmentioning

confidence: 99%

A new method to assess sinus rhythm maintenance likelihood before electrical cardioversion of persistent atrial fibrillation

Alcaraz

Rieta

2007

2007 Computers in Cardiology

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For many patients in persistent Atrial Fibrillation (AF), normal sinus rhythm (NSR) restoration use to be required to reduce the risk of stroke and improve cardiac output. Electrical cardioversion (ECV) is the most effective alternative to revert AF to sinus rhythm. However, because of the high risk of AF recurrence (especially during the first 2 weeks following the procedure) and because of potential collateral effects of ECV, it is clinically important to predict NSR maintenance after ECV before it is attempted. Thereby, the aim of this work is to obtain a robust and noninvasive predictor of NSR maintenance after ECV. The organization degree of the atrial activity (AA) obtained from surface electrocardiographic (ECG) recordings was estimated using a non-linear regularity index because it can be hypothesized that AF recurrence can be greater in those patients who present a highly disorganized AA. With the proposed strategy, 90.24% sensitivity and 78.57% specificity were obtained. Therefore, therapeutic interventions for the treatment of persistent AF could be improved, since unsuccessful electrical cardioversion and the consequent risks for the AF patients could be avoided. IntroductionAtrial Fibrillation (AF) is the most commonly sustained cardiac arrhythmia in clinical practice, with a prevalence of 0.5% in the adult population [1], rising to 10% or more in those over 75 years [2,3]. This disease can be divided into different forms, namely paroxysmal AF (selfterminating within 7 days), persistent AF (interventions are required for its termination), and permanent AF (sinus rhythm cannot be restored) [2]. For many patients in persistent AF, restoration and maintenance of normal sinus rhythm (NSR) is the main therapeutic goal because symptoms, cardiac output, and exercise tolerance are improved whereas the risk of stroke is reduced [2]. Thus, the first step in the rhythm control strategy is generally cardioversion. While chemical-induced cardioversion is sometimes possible, particularly with amiodarone [4,5], it is generally more unsuccessful than electrical cardioversion (ECV), specially if the arrhythmia has been present for more than 24 hours [6]. However, because of the high AF risk of recurrence, especially during the first 2 weeks following the procedure [7] and because of the potential secondary effects of ECV [8,9], it would be clinically useful to predict NSR maintenance after electrical cardioversion before it is attempted. In this way, the risks of cardioversion could be avoided for those patients with low NSR maintenance probability, and for the health care provider, the clinical cost could be optimized because unproductive treatment time and bed usage could be reduced.To date, numerous studies have attempted to find invasive and non-invasive parameters (clinical, electrophysiological, demographic, etc.) for the prediction of electrical cardioversion outcome for AF. However, very different and, consequently, inconclusive results have been obtained [10]. Thereby, the aim of this work is to ob...

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Introduction to Atrial Fibrillation

Bollmann¹,

Lombardi²

2008

Synthesis Lectures on Biomedical Engineering

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Atrial fibrillatory rate and sinus rhythm maintenance in patients undergoing cardioversion of persistent atrial fibrillation

Abstract: In patients undergoing cardioversion of persistent AF, AF relapse is predicted by a higher AFR. A stronger association is seen in patients with short arrhythmia duration, reflecting either rapid remodelling or pre-existing changes in those who relapse to AF.

Cited by 63 publications

References 36 publications

Noninvasive estimation of organization in atrial fibrillation as a predictor of sinus rhythm maintenance

Noninvasive estimation of organization in atrial fibrillation as a predictor of sinus rhythm maintenance

A new method to assess sinus rhythm maintenance likelihood before electrical cardioversion of persistent atrial fibrillation

Introduction to Atrial Fibrillation

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