Atrial fibrillation after electrical cardioversion in elderly patients: a role for arterial stiffness? Results from a preliminary study

Abstract

Background and aims Atrial fibrillation (AF) is the most frequent arrhythmia of the elderly, and electrical cardioversion (ECV) is a common procedure, although incidence of recurrences remains high. We evaluated the possible association between arterial stiffness (AS) and the persistence or recurrence of AF in elderly patients after ECV.MethodsWe enrolled all subjects undergoing ECV over a 9-month period. AS was evaluated with the cardio-ankle vascular index (CAVI). Patients were then visited at follow-up (on average at 6 months).ResultsThirty-one patients (age 78 ± 7 years; men 67.7 %; CHA2DS2-VASc 4.1 ± 1.6; AF length >2 months 51.6 %; CAVI 9.9 ± 1.6) underwent ECV. At follow-up, sinus rhythm was recorded in 16 (51.6 %) patients. At multivariate analysis, the presence of AF was directly associated with CHA2DS2-VASc score and CAVI. Amiodarone therapy reduced the risk of relapsed AF.ConclusionsIn elderly AF patients treated with ECV, AS at baseline seems to predict AF at follow-up.

Clinical significance of increased arterial stiffness associated with atrial fibrillation, according to Framingham risk score

“…Vascular stiffening is also associated with risk factors of AF, and high pulse pressure is known to be a risk factor for incident AF 3 , 29 . Moreover, arterial stiffness is known to affect recurrence rates of AF after elective cardioversion 30 . Impaired vascular function has shown improvement after restoration of sinus rhythm in patients with AF 31 .…”

Arterial stiffness and atrial fibrillation: a new and intriguing relationship

“…In the second study, we assessed the effects of AS on AF relapse after ECV, 15 enrolling 31 patients (mean age: 78 6 7 years), of which 67.7% were men. The prevalence of hypertension was high (87%), with a proportion of coronary artery disease, chronic heart failure and diabetes (29.1, 48.4, and 25.8%, respectively) greater than that observed in the previous study.…”

“…13 On this basis, we conducted two consecutive studies. 14,15 The first was aimed at determining the clinical factors correlated to AS in a population of patients who underwent external cardioversion (ECV) of the persistent forms of the arrhythmia. Then, we verified if an association exists between AS, left atrial and left ventricular dimensions.…”

“…14 With the second study, we aimed at evaluating in a new population of aged patients if AS can be related to sinus rhythm maintenance after ECV. 15 For this purpose, we took into consideration also interleukin-6 (IL-6) concentration, which revealed itself to be associated with both AS and AF relapses. 15,16…”

“…15 For this purpose, we took into consideration also interleukin-6 (IL-6) concentration, which revealed itself to be associated with both AS and AF relapses. 15,16…”