Role of dispersion of atrial refractoriness in the recurrence of clinical atrial fibrillation. A manifestation of atrial electrical remodeling in humans?

Fynn, Simon P.; Todd, Derick; Hobbs, Julian; Armstrong, Karen L.; Garratt, Clifford J.

doi:10.1016/s1062-1458(02)00570-6

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…In selected patients with ERAF, a focal source of AF originating from the pulmonary veins could be identified and treated successfully with catheter ablation technique 23 . In the remaining patients in whom no focal trigger could be detected, ERAF and subacute AF recurrence are probably related to electrical remodeling and heterogeneity, causing hypervulnerability of the atria after cardioversion 24–27 . In contrast, progressive atrial enlargement and pathophysiological adaptation, including loss of atrial myocyte with fibrosis and decrease coupling of myocytes, occurred in patient with long‐standing AF 28,29 .…”

Section: Predictors and Time Course Of Af Recurrencementioning

confidence: 99%

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

Tse

Lau

2003

Pacing Clinical Electrophis

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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.

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Section: Predictors and Time Course Of Af Recurrencementioning

confidence: 99%

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

Tse

Lau

2003

Pacing Clinical Electrophis

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Remodeling of cardiomyocyte ion channels in human atrial fibrillation

2003

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Beta-blockers prevent subacute recurrences of persistent atrial fibrillation only in patients with hypertension*1

VANNOORD¹

2004

Europace

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Compared with lone AF patients, patients in the setting of hypertension maintain sinus rhythm much better after cardioversion when treated with a beta-blocker. Beta-blockade protects, in particular, against the early subacute recurrences. These findings underscore the importance of a differential approach towards drug prevention of post-cardioversion recurrences depending on the underlying heart disease.

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Role of dispersion of atrial refractoriness in the recurrence of clinical atrial fibrillation. A manifestation of atrial electrical remodeling in humans?

Cited by 3 publications

References 23 publications

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

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

Remodeling of cardiomyocyte ion channels in human atrial fibrillation

Beta-blockers prevent subacute recurrences of persistent atrial fibrillation only in patients with hypertension*1

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