Reverse Electrical Remodeling of the Atria Post Cardioversion in Patients Who Remain in Sinus Rhythm Assessed by Signal Averaging of the P‐Wave

Abstract

Atrial electrical reverse remodeling occurs in patients with AF who maintain SR post-CV. This remodeling is likely inversely related to the duration of AF and LVH. SAPW duration does not predict recurrence of AF post-CV.

Impact of Obstructive Sleep Apnea on the Atrial Electromechanical Activation Time

“…23 Chalfoun et al demonstrated a strong correlation between FPD and atrial size in patients who remained in sinus rhythm (R 2 = 0.67, P=0.003), but not in those who returned to AF (R 2 = 0.11, P=0.65) after electrical cardioversion for persistent AF, and they suggested that the lack of correlation between atrial size and FPD in those who reverted back to AF might be related to electromechanical dissociation in their atria. 27 In patients with AF, such a discrepancy may be caused by fundamental limitations. First, cardiac imaging techniques are useful for determining atrial size or volume, but are not always accurate in obtaining adequate atrial images because the atria do not have a simple geometric shape.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…One study reported that the recurrence rate of AF following ablation was lower when treatment with dofetilide prior to ablation reduced the burden of AF, and was associated with a decrease in P wave duration. 617,618 Another single-center nonrandomized study found that amiodarone prolonged the cycle length of AF and reduced the time spent on CFAE ablation, but it did not have any effect on long-term outcomes. 619 A second single-center study treated patients with Class I or III drugs for long-standing persistent AF and compared the outcomes of ablation in those who were successfully converted to sinus rhythm months prior to ablation as opposed to those who were not.…”

Reverse atrial remodeling in patients who maintain sinus rhythm after electrical cardioversion: evidence derived from the measurement of total atrial conduction time assessed by PA-TDI interval

“…AF is related to left atrial fibrosis, the hallmark of structural atrial remodeling [5][6][7][8][9]. Electrical and structural atrial remodeling has been found to be independently associated with a higher recurrence rate of AF after eCV or catheter ablation [4,[9][10][11][12][13].…”