The Predictive Value of Transthoracic Echocardiographic Variables for Sinus Rhythm Maintenance after Electrical Cardioversion of Atrial Fibrillation

Abstract

Objectives: The recurrence rate of atrial fibrillation after electrical cardioversion is disappointingly high. The aim of the present study was to prospectively investigate if standard echocardiographic variables at the day of cardioversion could predict sinus rhythm maintenance. Methods: Transthoracic echocardiographic examination was performed within 4 h after cardioversion for all the patients in the CAPRAF (Candesartan in the Prevention of Relapsing Atrial Fibrillation) study. Results: Cardioversion was successful for 137 patients not given specific antiarrhythmic therapy, and only 41 (30%) maintained sinus rhythm at 6-month follow-up. There were significant (p = 0.05) lower transmitral A wave velocities in the group with relapsing atrial fibrillation compared with the group with sinus rhythm at 6-month follow-up. All patients with the lowest A wave velocities had an early recurrence of atrial fibrillation. There were no differences between the groups regarding atrial dimensions or left ventricular function. The use of the angiotensin II receptor antagonist candesartan had no influence on the echocardiographic variables, nor on the recurrence rate of atrial fibrillation after cardioversion. Conclusions: Transthoracic echocardiographic examination performed a short time after electrical cardioversion of atrial fibrillation showed that only A wave peak velocities were significantly predictive of sinus rhythm maintenance 6 months after the procedure.

High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors — a 28-30 years follow-up study

“…One investigator (I.G.) performed all of the echocardiograms using standard methods of measurements according to the recommendations of the American Society of Echocardiography [9,24].…”

“…The prevalence of atrial fibrillation (AF) among men younger than 40 years of age in the general population is as low as 0.5% and increases up to more than 15% in men who are 75 years or older [6,7]. The prevalence of LAF in different studies varies from 2 to 50% dependent on the chosen study population with AF [8,9].…”

Left atrial emptying fraction determined during atrial fibrillation predicts maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation

“…LA contractility during SR is also manifested by E wave velocity. Spiecker et al and Grundvold et al showed that A wave peak velocity is a risk factor for AF recurrence after DCCV [ 28 , 29 ]. Also, LA strain measured with tissue Doppler echocardiography [ 25 , 30 ] and speckle tracking echocardiography (STE) [ 31 , 32 ] and myocardial velocity of the left atrium appendage measured during AF [ 27 ] have prognostic value for SR maintenance after DCCV.…”

The electrical cardioversion of atrial fibrillation after 50 years since initial application: contemporary knowledge

“…Funkcję lewego przedsionka po kardiowersji w echokardiografii doplerowskiej odzwierciedla fala A napływu mitralnego. W randomizowanym badaniu CAPRAF [43], dotyczącym stosowania kandesartanu w prewencji AF, ocena prędkości fali A 4 godziny po kardiowersji miała istotną wartość predykcyjną dla nawrotu AF po 6 miesiącach obserwacji. Spiecker i wsp.…”