Predictors of atrial fibrillation recurrence in patients with long-lasting atrial fibrillation

Efremidis, Michalis; Alexanian, Ioannis; Oikonomou, Dimitrios; Manolatos, Dimitrios; Letsas, Κonstantinos P.; Pappas, Loukas K.; Gavrielatos, Gerasimos; Vadiaka, Maria; Mihas, Constantinos; Filippatos, Gerasimos; Sideris, Antonios; Kardaras, Fotios

doi:10.1016/s0828-282x(09)70070-4

Cited by 14 publications

(16 citation statements)

References 37 publications

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“…This finding might be of particular relevance because increased LA volume is usually thought to be important in the development of AF and is considered to be an important cause of unsuccessful sinus rhythm restoring and recurrence of AF. [34][35][36][37][38][39] Notably, our observations are in line with earlier studies 6 suggesting that the slow progression of atrial dilatation probably allows electrophysiological adaptations of the left atrial wall that permits to preserve the sinus rhythm for longer time. This finding also supports the possibility that in the clinical setting of patients with systolic CHF, additional factors other than LA size may exert their negative effects on an already diseased and vulnerable LA and contribute to AF development.…”

Section: Hemodynamic Mechanismssupporting

confidence: 90%

“…In fact, most of our patients maintained sinus rhythm during the entire follow‐up despite enlarged left atria at baseline. This finding might be of particular relevance because increased LA volume is usually thought to be important in the development of AF and is considered to be an important cause of unsuccessful sinus rhythm restoring and recurrence of AF …”

Section: Discussionmentioning

confidence: 93%

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Echocardiographically Derived Pulse Wave Velocity and Diastolic Dysfunction Are Associated with an Increased Incidence of Atrial Fibrillation in Patients with Systolic Heart Failure

et al. 2016

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Section: Hemodynamic Mechanismssupporting

confidence: 90%

Section: Discussionmentioning

confidence: 93%

Echocardiographically Derived Pulse Wave Velocity and Diastolic Dysfunction Are Associated with an Increased Incidence of Atrial Fibrillation in Patients with Systolic Heart Failure

et al. 2016

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“…This study of TOE DCCV performed in 112 patients, from a single tertiary hospital in Australia, demonstrates immediate and short-term success similar to published studies on this subject. Cardioversion resulted in an initial return to sinus rhythm in 87.6% of patients in this study, while the published immediate success rate ranges from 82-94.5% [25,27,35,36]. Amongst those with an initially successful cardioversion, sinus rhythm was maintained after 3 months in 57.7% of patients.…”

Section: Discussionmentioning

confidence: 61%

“…Several studies have attempted to identify potential predictors of successful DCCV, such as the absence of congestive heart failure, short duration of AF prior, or lower left atrial volume. Identifying these potential predictive factors is of clinical importance as they may be used to guide a physician's decision making in the management of patients in AF [24][25][26][27][28][29][30][31].…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

COA

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Background: Systemic thromboembolism is a serious complication of electrical cardioversion. Even in the absence of such complications there exists a significant rate of arrhythmia recurrence post cardioversion. Aims:The aim of this study was to identify factors that may aid clinicians in identifying those patients at increased risk of atrial thrombus formation and short-term arrhythmia recurrence. Methods:One-hundred and twelve patients were retrospectively identified across a 2.5 year period as having undergone electrical cardioversion at the Gold Coast University Hospital for atrial fibrillation or atrial flutter. Demographic, clinical and echocardiogram data was analysed to identify potential predictors of thrombus, unsuccessful cardioversion and arrhythmia recurrence.Results: Cardioversion was successful in 87.6% of patients. Cardioversion was more successful initially in males (p<0.01) and those with reduced atrial volume (p<0.01) and higher left ventricular ejection fraction (p<0.01).Arrhythmia recurrence within 3 months occurred in 57.7% of patients. Recurrence was more likely in those with congestive heart failure (p<0.05) and a longer pre-cardioversion duration of arrhythmia (p<0.05).Spontaneous echo contrast was observed in 3 (2.6%) of patients, whilst left atrial thrombus was observed in 7 (6.2%) of patients. Potential predictors of thrombus were congestive heart failure (p<0.05) and increased left atrial volume (p<0.01). Conclusions:This retrospective study identified a number of factors that may useful in the clinical setting in predicting cardioversion success, both initially and short-term, in addition to predicting thrombus formation.

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“…Increased LA size is strongly associated with lower SR rates following ECV in the short and longer term . Several studies have found an increased atrial diameter as a risk factor for AF recurrence, such as with left atrial diameter > 4.4 cm and 4.5 cm .…”

Section: Af and Patient Factorsmentioning

confidence: 99%

A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation

Ecker

Knoery

Rushworth

et al. 2018

Clinical Cardiology

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Atrial fibrillation is the most common heart-rhythm disorder, affecting about 1.5% to 2% of the population with an increased risk of mortality and morbidity due to stroke, thromboembolism, and heart failure. If the conversion back to sinus rhythm does not happen spontaneously, pharmacological or electrical cardioversion (ECV) is the next available treatment options for some patients. However, the long-term success following ECV is variable. This review describes the factors that are associated with maintenance of sinus rhythm following ECV and proposes a clinical strategy based on the available evidence.Atrial fibrillation (AF) is a supraventricular arrhythmia characterized by extremely rapid and uncoordinated electrical activity in the atria with variable conduction through the atrioventricular node, resulting in irregular, and often rapid, ventricular contraction. AF is the most common sustained heart-rhythm disorder in the developed world, found in 1% to 2% of the general population, with a higher prevalence in females and older patients.1 Because of an aging population, it is likely that AF patient numbers will continue to rise, along with associated increases in healthcare costs. 2 Palpitations, breathlessness, fatigue, and reduced exercise tolerance are AF-associated symptoms, and there is an increased risk of stroke with AF, with the need for anticoagulation. 2In some patients, AF will be permanent and therapy is aimed at controlling the ventricular rate (rate-control strategy). In other patients, normal rhythm initially can be restored with pharmacological or electrical cardioversion (ECV) but often requires additional strategies to maintain sinus rhythm (SR; rhythm-control strategy).There is no convincing mortality benefit to achieving rhythm control over rate control; therefore, treatment decisions are usually based on the presence of symptoms and the perceived likelihood of successful cardioversion. Cardioversion can be achieved by pharmacological methods or ECV; however, maintenance of SR may only be temporary. [3][4][5][6][7] The use of ECV may be indicated where pharmacological rhythm-control strategies have failed and the patient remains symptomatic. Patient selection is important, as the maintenance of longterm SR can be difficult. The advantages of ECV are that it is associated with a high initial success rate (68%-98%) 8 ; however, it requires sedation or general anesthesia, and although initially successful, longterm maintenance of SR is not reliably achieved. 9 AF relapse following ECV is also associated with increased mortality, 10 thus highlighting the importance of identifying the correct patient group for cardioversion and, where possible, addressing reversible factors associated with poorer outcomes. Furthermore, it is crucial at the time of ECV that patients are appropriately prepared with adequate hydration and correction of any electrolyte abnormalities. ECV should also be avoided in stable patients with concurrent infection or significant inflammation.Many factors have been reported ...

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Predictors of atrial fibrillation recurrence in patients with long-lasting atrial fibrillation

Cited by 14 publications

References 37 publications

Echocardiographically Derived Pulse Wave Velocity and Diastolic Dysfunction Are Associated with an Increased Incidence of Atrial Fibrillation in Patients with Systolic Heart Failure

Echocardiographically Derived Pulse Wave Velocity and Diastolic Dysfunction Are Associated with an Increased Incidence of Atrial Fibrillation in Patients with Systolic Heart Failure

Untitled

A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation

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