Prediction of atrial fibrillation recurrence after cardioversion in patients with left-atrial dilation

Möller

et al. 2016

Clinical Cardiology

Background: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial sphericity index (LASI) acquired by 2-dimensional transthoracic echocardiography (TTE) could be used as a predictor of AF recurrence after successful DCC. Hypothesis: A baselline LASI assessed by 2D TTE can predict AF recurrence after successful DCC in patients with persistent AF. Methods: A total of 124 consecutive patients with persistent AF lasting <120 days underwent successful DCC. Other than β-blockers, no other antiarrhythmic treatment was administered. Prior to DCC, all patients underwent thorough TTE, and LASI was calculated as the fraction of the left atrial width/length of the largest possible left atrial volume in a 4-chamber view. The primary outcome was a TTE-estimated baseline LASI as a predictor of AF recurrence after successful DCC for persistent AF. Results: Anatomically, a more spherical shape of the left atrium (LASI >0.9) proved to be a strong and independent predictor of AF recurrence, with an odds ratio between 4.1 (95% confidence interval: 1.6-11.9, P = 0.005) and 7.6 (95% confidence interval: 3.3-19.7; P = 7.2 × 10 −6 ). The receiver operating characteristic curve indicated good power for distinguishing between recurring and nonrecurring AF, and we chose a cutoff of 0.9 because high specificity was a priority for clinical reasons. Conclusions: In conclusion, baseline LASI >0.9 was associated with significantly greater AF recurrence throughout the 12-month follow-up period.

Section: Discussionmentioning

confidence: 82%

Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct‐Current Cardioversion: An Echocardiographic Study

Möller

et al. 2016

Clinical Cardiology

“…The septal E/e' ratio ≥ 11 is an index of elevated LV filling pressure (> 15 mm Hg) with a sensitivity of 75% and a specificity of 93% and reflects higher LA pressure [17]. Elevated E/e' ratio served as a predictor of recurrence after catheter ablation of AF [18] and an independent predictor of AF recurrence after cardioversion [19]. Septal E/e' ratio was also an independent predictor of mortality in patients with non-valvular AF [20].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of POAF differed significantly according to the type of surgery, with the highest frequency in patients undergoing combined aorta and valvular surgery (34.4%) followed by isolated valvular surgery (33.0%). The POAF group included significantly fewer patients who underwent OPCAB than the no POAF group (19 Development of POAF occurred after mean 3.77 ± 4.62 post-operative days. Of the 207 patients with POAF, 41 patients were treated with anti-arrhythmic drugs, 18 patients underwent electrical cardioversion in the immediate postoperative period, 7 patients underwent scheduled electrical cardioversion after failure of converting to sinus rhythm with anti-arrhythmic drugs, and 141 patients received only rate-control drugs during hospitalization.…”

Section: Baseline Characteristics According To the Poafmentioning

confidence: 99%

Newly developed post-operative atrial fibrillation is associated with an increased risk of late recurrence of atrial fibrillation in patients who underwent open heart surgery: Long-term follow up

et al. 2017

Anaesthesiol Intensive Ther

“…Again, the available trials (PRCT) included all degrees of diastolic dysfunction without any attempt to stratify the degree of dependence of the ventricular filling on the atrial systole. Moreover, with exemption of the AF-CHF trial [113], the authors included all patients without stratification of the LV systolic function, and related left atrial remodelling which relates to the ability to maintain a sinus rhythm [117,118].…”

Section: Discussionmentioning

confidence: 99%

Management of arrhythmia in sepsis and septic shock

Borggrefe¹,

Matoušek²,

Malý³

et al. 2017

The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.