Burden and Timing of Premature Atrial Contractions After Electrical Cardioversion of Persistent Atrial Fibrillation Do Not Predict Its Recurrence

Abstract

Background:The heart is susceptible to recurrence of atrial fibrillation (AF) during the period immediately following conversion to sinus rhythm (SR). It is less clear whether various onset or trigger mechanisms can predict AF recurrence after direct current (DC) cardioversion of persistent AF. Methods: In this study, 172 patients (117 men), mean age 69±11 y, and with persistent AF underwent elective electrical cardioversion. A detailed analysis was made of the heart rhythm and potential AF trigger mechanisms based on 5 min electrocardiogram (ECG) recordings after conversion. Results: Of 151 patients discharged in SR, 45 (30%) had a recurrence of AF within 1 wk. Premature atrial contractions (PACs) were the most common potential trigger, occurring on an average of 3/min. They were equally frequent in patients with and without immediate and early reinitiation of AF, and in patients with and without AF recurrence at the 1-wk follow-up visit. Other trigger mechanisms were too infrequent to allow conclusions. Conclusion: Premature atrial contractions were the most common potential trigger mechanism occurring immediately after cardioversion in patients with persistent AF. However, they neither predicted immediate and/or early reinitiations, nor recurrences during the first wk after cardioversion.

Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation

“…Additional observations in patients undergoing cardioversion for AF have shown excessive APC frequency before cardioversion to be associated with higher rate of AF recurrence post cardioversion. [16][17][18] It appears that not only do APCs predict new AF; they also act as a surrogate marker for existing paroxysmal AF. This explains increased risk of stroke in patients with frequent APCs in the absence of documented AF.…”

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Sinus Bradycardia and Sinus Pauses Immediately after Electrical Cardioversion of Persistent Atrial Fibrillation—What Do They Mean?

“…Laboratory evaluation included electrolytes, thyroid and liver function tests. Echocardiography was performed on clinical indications at the discretion of the AF clinic physician . All patients were treated with warfarin for at least 4 weeks before cardioversion with an international normalized ratio (INR) level within the target interval of 2.0–3.5.…”