Clinical Predictors and Time Course of Arrhythmia Recurrence in Patients with Early Reinitiation of Atrial Fibrillation After Successful Internal Cardioversion

Abstract

Early reinitiation of atrial fibrillation (ERAF) was commonly observed after successful electrical cardioversion, however, the effect of ERAF on the subsequent time course of arrhythmia recurrence remains unclear. The aim of this study was to evaluate the clinical predictors and time course of AF recurrence with respect to the occurrence of ERAF after successful cardioversion. The clinical predictors and time course of AF recurrence were prospectively evaluated in 124 patients (94 men, 30 women; mean age 65 +/- 9 years) with persistent AF (mean AF duration 36 +/- 40 months), who underwent internal cardioversion. After cardioversion, all patients received treatment with sotalol and were monitored for AF recurrence. Successful restoration of sinus rhythm was achieved in 104 (84%) of 124 patients. ERAF was observed in 28 (27%) of 104 patients in whom 26 of them were successfully treated acutely with intravenous sotalol and repeated cardioversion. After a mean follow-up of 26 months, 29 (28%) of 104 patients remained in sinus rhythm. Kaplan-Meier analysis revealed a significantly poorer outcome with regard to the recurrence of AF in patients with ERAF (hazard ratio 1.7,P = 0.03) and in those with AF for more than 3 years (hazard ratio 1.6,P = 0.03). Despite treatment with sotalol, patients with ERAF had a significantly higher AF recurrence rate within the first day (13/26 [50%] vs 12/76 [16%],P < 0.01), but not during long-term follow-up (21/26 [81%] vs 52/76 [68%],P = 0.3). In contrast, patients with AF for more than 3 years had a similar AF recurrence rate within the first day (7/29 [24%] vs 18/73 [25%],P = 1.0), but a significantly higher recurrence rate during long-term follow-up (27/29 [93%] vs 46/73 [37%],P < 0.01). In conclusion, the occurrence of ERAF and long AF duration were independent predictors for AF recurrence after successful internal cardioversion. The difference in the time course of AF recurrence in patients with ERAF from those with long AF duration suggests distinct arrhythmogenic mechanisms.

Plasma levels of NT-pro-BNP in patients with atrial fibrillation before and after electrical cardioversion

“…Recurrence of atrial fibrillation after successful electrical cardioversion can often be found. In our study, about 30% of patients suffered from atrial fibrillation again 11 days later, which is in agreement with reports of recurrence rates between 50 and 70% during one year [17]. Since studies showed that restoration of sinusrhythm is not strictly superior to heart rate control [9,16], a suitable biomaker for prediction of atrial fibrillation recurrence is needed to select patients who will benefit from an electrical cardioversion in the long term.…”

Spectral turbulence analysis of the signal-averaged electrocardiogram of the atrial activation as predictor of recurrence of idiopathic and persistent atrial fibrillation

“…Also, it has been frequently employed as the first choice due to its beta-blocking activity for controlling the ventricular rate [48]. On the other hand, amiodarone is considered to be more efficient than dl-sotalol in maintaining sinus rhythm after cardioversion [49,50]. However, its use is limited due to possible side effects, although it was not found any side effect that needed interruption of the treatment in this study.…”

Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence

“…Another significant predictor for recurrence in our study was the occurrence of IRAF, similarly to what has been shown in humans. 45 Immediately after cardioversion, the atrial tissue is a supervulnerable substrate for IRAF as the atrial effective refractory period and the conduction velocity are markedly decreased, widening the window of inducibility of AF by an APD. 46 IRAF is often initiated by a short‐coupled APD, 47 and 3 of the 5 horses with IRAF in this analysis had a high burden of APDs and 1 even runs of AT on their 24‐hour ECG 5 days after cardioversion, which might indicate the underlying presence of a firing focus increasing the risk for AF reinitiation.…”

“… 46 IRAF is often initiated by a short‐coupled APD, 47 and 3 of the 5 horses with IRAF in this analysis had a high burden of APDs and 1 even runs of AT on their 24‐hour ECG 5 days after cardioversion, which might indicate the underlying presence of a firing focus increasing the risk for AF reinitiation. 45 , 48 , 49 …”

“…46 IRAF is often initiated by a short-coupled APD, 47 and 3 of the 5 horses with IRAF in this analysis had a high burden of APDs and 1 even runs of AT on their 24-hour ECG 5 days after cardioversion, which might indicate the underlying presence of a firing focus increasing the risk for AF reinitiation. 45,48,49 The choice of the authors to exclude the horses that experienced ERAF from the recurrence analysis was related to this increased sensitivity for induction of AF in an electrically remodeled atrium. Reverse electrical remodeling takes at least 3 to 7 days to be completed in humans, 28 dogs, 29 and goats, 27 and during this period the atria are F I G U R E 2 Kaplan-Meier survival curves for horses grouped by sex (N = 175; 58 mares, 18 stallions, 99 geldings).…”