Factors Influencing Persistence of Sinus Rhythm After Dc Shock Treatment of Atrial Fibrillation

Waris, E; Kreus, K.‐E.; Salokannel, Juhani

doi:10.1111/j.0954-6820.1971.tb04358.x

Cited by 69 publications

(3 citation statements)

References 21 publications

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“…A study by Waris et al showed that if the SN has sustained only partial damage to its structure, it is more likely to recover after DC cardioversion even after years of AF. 58 In another study by Daoud et al, progressive recovery of SNRT and P wave amplitude T were observed in patients with chronic AF only after 14 days and much more after 3 months post ablation. 47 For some individuals, duration of AF/AFL may not be critical: in a case report by Palma et al SN function was noted to return to normal one day following ablation of chronic (25 years) atrial flutter.…”

Section: Pafmentioning

confidence: 89%

Sinus Node Dysfunction in Atrial Fibrillation: Cause or Effect?

Fisher¹,

Kezerashvili²,

Krumerman³

2008

J.AFIB

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Section: Pafmentioning

confidence: 89%

Sinus Node Dysfunction in Atrial Fibrillation: Cause or Effect?

Fisher¹,

Kezerashvili²,

Krumerman³

2008

J.AFIB

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“…After 1 year, 70% may have reverted back to AF [4]. Maintenance of sinus rhythm may be improved by selection of appropriate patients [4-7], the use of antiarrhythmic drugs, or repeat DCCV [8]. Despite this, the long term success of the procedure remains poor.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive Pharmacotherapy for Elective Direct Current Cardioversion in Patients With Atrial Fibrillation

Hirt

Gobin

2012

Cardiol Res

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BackgroundDirect current cardioversion (DCCV) can restore sinus rhythm in patients with atrial fibrillation (AF), but the long term efficacy is poor. Pharmacological therapies may improve the initial success of the procedure, but whether long term maintenance of sinus rhythm can be improved is unclear. The aim of this study was to evaluate which pharmacotherapies, including antiarrhythmic and renin-angiotensin-aldosterone system (RAAS) inhibiting drugs, most successfully promotes sinus rhythm after elective DCCV in unselected patients with atrial fibrillation.MethodsA retrospective cohort was to study of AF patients attending or DCCV between Jan 2010 and Feb 2012. The data were analysed using multivariate logistical regression models. Initial success of DCCV was the dependent variable in the first analysis. Maintenance of sinus rhythm at follow up was the dependent variable in the second analysis.ResultsOne hundred and thirty patients were included in the first analysis, and 71 patients were included in the second analysis. The only association observed was a positive association between flecainide and an increased odds of maintaining sinus rhythm at follow up (OR 2.14, SE ± 0.93, P = 0.02) .Other antiarrhythmic drugs and RAAS inhibiting drugs had no association with an increased odds of successful DCCV or maintenance of sinus rhythm thereafter.ConclusionsThis is the first study to demonstrate an association between flecainide and a increased odds of maintaining sinus rhythm after DCCV in the long term. This warrants further research, and should be taken into account when choosing adjunctive antiarrhythmic therapy for elective DCCV for AF.

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“…Persistent AF usually progresses to a permanent form and the successful restoration and maintenance of sinus rhythm largely depend on arrhythmia duration, with longstanding AF being more resistant to cardioversion and more prone to recurrence [6][7][8][9] . Both resistance to cardioversion and tendency of recurrence are strongly related to the development of electrophysiological substrates characterized by shortened atrial effective refractory period 2,4,5,[10][11][12][13] , slow conduction in the atrial myocardium 10,11,[14][15][16] and dispersion of refractoriness 4,13,17,18 .…”

Section: Introductionmentioning

confidence: 99%

Remodelagem atrial elétrica reversa após cardioversão de fibrilação atrial isolada de longa duração

Barbosa¹,

Benchimol-Barbosa²,

Bomfim³

et al. 2009

Arq. Bras. Cardiol.

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Background: Atrial fibrillation (AF) itself promotes electrophysiological changes, termed "electrical remodeling", facilitating its recurrence and maintenance. There is evidence that the remodeling process is reversible after restoration of the sinus rhythm (SR). However, the timing for the recovery of electrophysiological properties is still undefined.Objctive: The aim of this study was to assess the atrial electrical activation using P-wave signal-averaged electrocardiogram (P-SAECG) post-cardioversion of long-standing AF, focusing on the reversal remodeling process to identify the timing of the process stabilization.Methods: Subjects with lone persistent AF, eligible for cardioversion and successfully converted to SR, were enrolled at the study. SAECG was performed immediately after reversion to SR and repeated on days seven and thirty.Results: Of 31 subjects, nine presented early recurrence of atrial fibrillation, all of them in the first seven days postcardioversion; 22 remained in SR for at last one month and SAECG was obtained on days seven and thirty after cardioversion. In the latter, P-wave duration progressively abated from the first to the third SAECG (P-wave duration: 185.5±41.9 ms vs 171.7±40.5 ms vs 156.7±34.9 ms, respectively, first, second and third SAECG; p<0.001 for all matches). In the frequency domain analysis, spectral turbulence was not apparent in SAECG immediately postcardioversion, but sharply increased on day seven and remained unchanged on day thirty. Conclusion IntroductionAtrial fibrillation (AF) has been described as a selfperpetuating arrhythmia, which promotes electrophysiological changes in atrial tissue, facilitating its recurrence and maintenance [1][2][3][4][5] . Persistent AF usually progresses to a permanent form and the successful restoration and maintenance of sinus rhythm largely depend on arrhythmia duration, with longstanding AF being more resistant to cardioversion and more prone to recurrence [6][7][8][9] . Both resistance to cardioversion and tendency of recurrence are strongly related to the development of electrophysiological substrates characterized by shortened atrial effective refractory period 2,4,5,[10][11][12][13] , slow conduction in the atrial myocardium 10,11,[14][15][16] and dispersion of refractoriness 4,13,17,18 . These changes can be induced by both rapid atrial pacing and AF itself, and have been termed "electrical remodeling" 2 . The resultant electrophysiological abnormality is the presence of multiple wavelets around the atria, some of which circle back on them creating multiples reentry circuits, as proposed by Moe et al 19,20 in 1962 and 1964, and later confirmed by Allessie et al 21 in 1985.In animal models, the remodeling process has been demonstrated to be reversible after restoration of the sinus rhythm, and is characterized by progressive increase in both atrial conduction velocity and refractoriness (reversal remodeling) 1,2,10,11,13,22 . Recovery has also been demonstrated in human atria 3,[23][24][25][26] . On the other hand, a remarkab...

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Factors Influencing Persistence of Sinus Rhythm After Dc Shock Treatment of Atrial Fibrillation

Cited by 69 publications

References 21 publications

Sinus Node Dysfunction in Atrial Fibrillation: Cause or Effect?

Sinus Node Dysfunction in Atrial Fibrillation: Cause or Effect?

Adjunctive Pharmacotherapy for Elective Direct Current Cardioversion in Patients With Atrial Fibrillation

Remodelagem atrial elétrica reversa após cardioversão de fibrilação atrial isolada de longa duração

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