Doppler echocardiographic parameters predictive of recurrence of atrial fibrillation of different etiologic origins.

Abstract

Atrial fibrillation is a common arrhythmia associated with an increased risk for the occurrence of embolism. Recurrences of atrial fibrillation are very frequent and increase the risk for an embolic event. The aim of the present study was to identify the clinical and echocardiographic parameters that are predictive of the recurrence of atrial fibrillation. One hundred and twenty consecutive patients with non-rheumatic atrial fibrillation were followed for 1 year after cardioversion. The following parameters were evaluated: cause and duration of atrial fibrillation, modality of cardioversion, atrial function after cardioversion (peak A wave velocity and A wave integral), left atrial dimension, peak E wave velocity of the transmitral inflow pattern, acceleration and deceleration times, and the integral of E wave. At 1 year, 72 patients maintained sinus rhythm whereas 48 patients had a recurrence of atrial fibrillation. The univariate analysis revealed that the parameter with the strongest influence on the recurrence of atrial fibrillation was the peak A velocity after cardioversion (P < 0.001). The other parameters associated with recurrences were cause of atrial fibrillation (P < 0.001), duration of arrhythmia (P = 0.002), and left atrial dimension (P = 0.05). The modality of cardioversion and the E wave variables did not influence the recurrence of atrial fibrillation. The peak A velocity was smaller in the group of patients who had a recurrence. We suggest that clinical and echocardiographic parameters, such as A wave variables, be used to identify patients at risk for recurrence. These patients should be monitored more frequently and should eventually be treated with antiarrhythmic drugs.

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

“…Similar to earlier studies [3, 5, 6, 13], we found a significant, although not highly predictive, correlation between A wave peak velocity a short time after cardioversion and sinus rhythm maintenance.…”

“…However, such predictivity of the A wave was not visible at 4 h after cardioversion in their study. The results from Mattioli et al [3] showed that left atrial dimension and peak A wave velocity were strong predictors of sinus rhythm maintenance. Their population was characterized by a short duration of atrial fibrillation (48% <24 h, only 18% >1 month) and they were all treated with pharmacological cardioversion.…”

“…In the literature, recurrence of atrial fibrillation after cardioversion has been found to be associated with transthoracic echocardiographic parameters like left atrial diameter, left ventricular function and mitral inflow A wave velocity. Most of these studies are retrospective or include a limited number of patients, and the results are to some degree conflicting [2,3,4,5,6,7]. …”

Atrial Fibrillation in Hypertension

“…In the study by Ciaroni and coworkers, only the A-wave velocity was a predictor of AF. 17 In a study by Mattioli and coworkers, 20 patients with recurrence of AF were more likely to have a larger left atrium and a smaller A-wave after cardioversion. The possibility that LV diastolic dysfunction may contribute to trigger AF in uncomplicated hypertensive subjects through an increase in left atrial pressure is attractive but difficult to investigate in epidemiological studies.…”

Angiotensin&nbsp;II receptor blockers in the prevention of complications from atrial fibrillation

“…[12][13][14][15][16][17][18] Patients who initially present with paroxysmal AF often progress to longer, non-self-terminating bouts, 19 and enlarged atria are a major risk factor for its recurrence. 20,21 Current treatment strategies for AF include the prevention of thromboembolism and either rate-control or rhythmcontrol strategies, with pharmacotherapy or left atrial ablation as first-or second-line therapy options, respectively. 8 These approaches may produce similar outcomes, but rate control may be preferable because agents used to maintain sinus rhythm can have proarrhythmic effects.…”