Likelihood of Spontaneous Conversion of Atrial Fibrillation to Sinus Rhythm

Danias, Peter G.; Caulfield, Todd A.; Weigner, Marilyn J.; Silverman, David I.; Manning, Warren J.

doi:10.1016/s0735-1097(97)00534-2

Cited by 180 publications

(93 citation statements)

References 29 publications

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“…22 Our study identifies the selective subgroups of the patients who are likely to respond to ibutilide. The clinical and echocardiographic parameters associated with a high response rate include presence of CAD (77%), absence of MVD (82%), absence of markedly enlarged LA (67%), and absence of enlarged LA as well as absence of MVD (85%).…”

Section: Discussionmentioning

confidence: 98%

“…The half-life is 2 to 12 h (mean 6 h). [20][21][22][23][24][25] Among the class III and class I antiarrhythmic agents, ibutilide is one of the most effective agents for cardioversion, and most of the patients convert to sinus rhythm within 1 h of initiation of therapy. [27][28][29][30] All patients should be monitored closely for 4 h, as there is a 2 to 3% risk of torsade de pointes and occasional hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…The mean LA size of our study was comparable with previous studies (mean 4.5 ± 0.9) and varied from 3.2 ± 1.2 to 4.3 ± 1.1 cm and 4.5 ± 0.7 to 4.6 ± 0.9 cm, respectively. 22,24 Patients were considered to have MVD even though it was clinically insignificant and echocardiography revealed only mild MR. Change in atrial geometry, even by a small MR jet, may to be responsible for atrial myopathy and a substrate for the reentrant circuits or chaotic rhythm. This may sets up a milieu compatible for AF and resistance to ibutilide therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20][21] The spontaneous conversion rate in new onset AF within the first 24 h is as high as 50-70% with highest incidence in the first 8 h, and it drops to < 8 % after 24 h. Therefore, only half of the patients with new onset AF will require cardioversion if monitored for > 24 h. It has also been shown to be cost effective when the patients are treated with direct current (DC) cardioversion. 22 We evaluated the response rate of ibutilide in AF of > 24 h duration to minimize the chance of spontaneous conversion.…”

Section: Introductionmentioning

confidence: 99%

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Cardioversion of atrial fibrillation with ibutilide: When is it most effective?

Das

Cheriparambil

Bedi

et al. 2002

Clinical Cardiology

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SummaryBackground: Atrial fibrillation (AF) is found in 1% of persons above the age of 60 years. More than 5% of the population older than 69 years and about 14% of octogenarians are at risk for this arrhythmia. It is estimated that 1.5 to 3 million persons in the United States alone suffer from AF. The public health implications and attendant morbidity are a significant drain on our health care system.Hypothesis: The purpose of this study was to determine the clinical and echocardiographic predictors of success in converting AF of ≥ 24 h duration.Methods: Demographic and clinical and echocardiographic parameters of 101 patients with recent onset AF (> 24 h) who received ibutilide were studied.Results: Of 101 patients, 56 (55%) converted to sinus rhythm. Age, gender, hypertension, diabetes mellitus, left ventricular ejection fraction (≤ 35%), congestive heart failure, and previous medication for rate control had no significant effect on the conversion rate. Conversion rate was only 30% (9/30 patients) in the presence of an enlarged left atrium (LA ≥ 5 cm) and 37.7% (23/61 patients) in the presence of mitral valve disease (MVD), whereas the conversion rate was 82.5% (33/40 patients) in the absence of MVD and 85% (29/34 patients) in the absence of both enlarged LA and MVD (p = < 0.001). Patients with coronary artery disease (CAD) also exhibited a significantly greater response to ibutilide than patients without CAD (77 vs. 46%, p-value 0.005).Conclusion: As a therapy for cardioversion of AF, ibutilide is most effective in a selected subgroup patients, such as in pa-

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardioversion of atrial fibrillation with ibutilide: When is it most effective?

Das

Cheriparambil

Bedi

et al. 2002

Clinical Cardiology

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“…Rate of spontaneous conversion in this group might be as high as 50% over the first 48 h, 11 and even higher in patients with shorter duration of AF at admission. 12 A placebo could expose the real value of our strategy more accurately. Data from our retrospective chart review showed a similar rate of conversion.…”

Section: Discussionmentioning

confidence: 99%

Successful Conversion of Recent‐onset Atrial Fibrillation by Sequential Administration of up to Three Antiarrhythmic Drugs

Miličević¹,

Gavranović²,

Bakula³

et al. 2008

Clinical Cardiology

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Background: Short-term conversion attempt of recent-onset atrial fibrillation (AF) in the emergency room fails too often. Many patients and doctors still prefer pharmacological to electrical solutions in such cases. Hypothesis: Sequential administration of up to 3 antiarrhythmic drugs of different classes of action (amiodarone, propafenone, and quinidine) may achieve conversion in such patients. Method: One hundred and forty consecutive patients with recent-onset AF were transferred to the intensive cardiac care unit after a failed 2-h conversion attempt in the emergency room. First-line drug for conversion was continued up to a full dose, and was chosen by AF etiology, or in recurrent AF episodes, empirically. In nonresponders, the failed drug was replaced by a drug of another class, and if the second-line drug failed it was replaced by a drug of the third-line. Electrical cardioversion was the final solution for nonresponders. Results: Sixty percent of patients reached sinus rhythm by the first-line drug therapy, 34% by the second-line, and 4% by the third-line. Seventy-five percent of patients achieved conversion within 26 h, and 95% of patients achieved conversion within 40 h. Three patients were electrically cardioverted due to hemodynamical instability. Two episodes of Torsade de Pointes ventricular tachycardia were self-terminated. Conclusion: Sequential usage of up to 3 antiarrhythmic drugs of different classes of action provides almost complete success in conversion of recent-onset AF in patients refractory to short-term conversion attempt in the emergency room.

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The Burden of Hospitalization for Atrial Fibrillation

Carter¹

2012

Arch Intern Med

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Likelihood of Spontaneous Conversion of Atrial Fibrillation to Sinus Rhythm

Abstract: Spontaneous conversion to sinus rhythm occurs in almost 70% of patients presenting with atrial fibrillation of <72-h duration. Presentation with symptoms of <24-h duration is the best predictor of spontaneous conversion.

Cited by 180 publications

References 29 publications

Cardioversion of atrial fibrillation with ibutilide: When is it most effective?

Cardioversion of atrial fibrillation with ibutilide: When is it most effective?

Successful Conversion of Recent‐onset Atrial Fibrillation by Sequential Administration of up to Three Antiarrhythmic Drugs

The Burden of Hospitalization for Atrial Fibrillation

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