Chronic atrial fibrillation. Success of serial cardioversion therapy and safety of oral anticoagulation

Abstract

Many patients with chronic atrial fibrillation failed to respond to the serial electrical cardioversion strategy. However, in younger patients with a fair exercise tolerance and a duration of atrial fibrillation shorter than 36 months, this approach may be worthwhile. In addition, thromboembolic events were infrequent in the patients who were subjected to this regimen.

Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013)

“…Although persistent AF cannot be terminated with pharmacological cardioversion except when certain types of antiarrhythmic drugs are used, patients respond well to electrical cardioversion, and 94% of them return to sinus rhythm. 56 AF frequently recurs after cardioversion: the percentages of patients who remain in sinus rhythm with common pharmacotherapy are about 50% at year 1, 40% at year 2, and 30% at year 3. 56 The rate of recurrence differs depending on patient characteristics, and known risk factors for AF recurrence include advanced age, hypertension, heart failure, and duration of AF episode.…”

Clinical Profiles, Efficacy of Antiarrhythmic Drug Therapy, and Cardiovascular Prognosis in Patients With First Detected Paroxysmal Atrial Fibrillation

“…10,23) Independent risk factors for the chronic form of paroxysmal AF are considered to be advanced age, female, underlying heart disease, AF history, left atrial dilation, and heart failure. 24,25) According to a Japanese report on the long-term natural course of paroxysmal AF, the percentage of patients in whom paroxysmal AF became permanent was about 5.5% per year.…”

Pharmacologic and Non-Pharmacologic Treatment of Chronic Atrial Fibrillation – With Special Reference to Valvular Atrial Fibrillation in Rheumatic Heart Disease

“…Predictors of recurrence of AF include long standing atrial fibrillation (duration greater than three months), heart failure, structural heart disease, hypertension, increasing age (over 70), and increased left atrial size 10 . Although left atrial size is related to the duration of AF, a left atrial diameter greater than 6.5 cm is associated with an increased risk of recurrence 11 .…”