Maintenance of sinus rhythm after atrial defibrillation.

Szekely, Paul; Sideris, D.A.; Batson, G A

doi:10.1136/hrt.32.6.741

Cited by 68 publications

(21 citation statements)

References 10 publications

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“…Cardioversion of AF after corrective mitral valve surgery permits restoration and maintenance of sinus rhythm in some patients, but many relapse into AF. 16 The results of the present study suggest that once fibrotic atrial structural remodeling has occurred, it is irreversible. It may therefore be …”

Section: Potential Significancementioning

confidence: 66%

Dynamic Nature of Atrial Fibrillation Substrate During Development and Reversal of Heart Failure in Dogs

et al. 2002

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Background-Clinical atrial fibrillation (AF) often results from pathologies that cause atrial structural remodeling. The reversibility of arrhythmogenic structural remodeling on removal of the underlying stimulus has not been studied systematically. Methods and Results-Chronically instrumented dogs were subjected to 4 to 6 weeks of ventricular tachypacing (VTP; 220 to 240 bpm) to induce congestive heart failure (CHF), followed by a 5-week recovery period leading to hemodynamic normalization at 5-week recovery (Wk5 rec ). The duration of burst pacing-induced AF under ketamine/ diazepam/isoflurane anesthesia increased progressively during VTP and recovered toward baseline during the recovery period, paralleling changes in atrial dimensions. However, even at full recovery, sustained AF could still be induced under relatively vagotonic morphine/chloralose anesthesia. Wk5 rec dogs showed no recovery of CHF-induced atrial fibrosis (3.1Ϯ0.3% for controls versus 10.7Ϯ1.0% for CHF and 12.0Ϯ0.8% for Wk5 rec dogs) or local conduction abnormalities (conduction heterogeneity index 1.8Ϯ0.1 in controls versus 2.3Ϯ0.1 in CHF and 2.2Ϯ0.2 in Wk5 rec dogs). One week of atrial tachypacing failed to affect the right atrial effective refractory period significantly in CHF dogs but caused highly significant effective refractory period reductions and atrial vulnerability increases in Wk5 rec dogs. Conclusions-Reversal of CHF is followed by normalized atrial function and decreased duration of AF; however, fibrosis and conduction abnormalities are not reversible, and a substrate that can support prolonged AF remains. Early intervention to prevent fixed structural abnormalities may be important in patients with conditions that predispose to the arrhythmia.

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Section: Potential Significancementioning

confidence: 66%

Dynamic Nature of Atrial Fibrillation Substrate During Development and Reversal of Heart Failure in Dogs

et al. 2002

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“…The cardioversion of unselected atrial fibrillation patients results in consistently high rates of relapse into atrial fibrillation and at 1 year 40 to 80% or more patients successfully cardioverted will have reverted to atrial fibrillation [18][19][20][21][22][23][24][25] . A number of authors have tried to establish those characteristics which identify patients at high risk of relapse following cardioversion [22,24,26] and have suggested the duration of atrial fibrillation prior to cardioversion is a critical predictor of outcome. It is now common practice to limit cardioversion to patients with atrial fibrillation of less that 1 or 2 years' duration.…”

Section: Discussionmentioning

confidence: 99%

Is there a place for the late cardioversion of atrial fibrillation?. A long-term follow-up study of patients with post-thyrotoxic atrial fibrillation

Nakazawa

Lythall²,

Noh³

et al. 2000

European Heart Journal

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Aims As atrial fibrillation is associated with significant mortality and morbidity, restoration of sinus rhythm is desirable. However, previous data suggest that cardioversion should be restricted to patients in whom the fibrillation is of limited duration (<1-2 years) because of high relapse rates. It may be the frequent association with cardiac disease, rather than the duration of fibrillation itself, which determined the high relapse of earlier studies. The aim of this study was to investigate rates of cardioversion, maintenance of sinus rhythm and predictors of subsequent relapse in a homogeneous group of patients without evidence of any co-existent cardiac disease. Methods and ResultsWe report on a retrospective series of 106 patients with thyrotoxicosis-induced fibrillation but no other heart disease: 87% had been in atrial fibrillation for >12 months (median duration 28·5, interquartile range 15-47 months). Cardioversion was attempted using disopyramide and then electric shock. Ninety-eight patients were successfully cardioverted: at late follow-up, 80·6 37 months (mean SD), 67% were in sinus rhythm. ConclusionAlthough a relationship between the duration of fibrillation and maintenance of sinus rhythm was found, the high proportion remaining in sinus rhythm, compared with other series, suggests this influence may be less important than the presence or absence of structural heart disease.

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“…However, long-term maintenance of sinus rhythm after successful electrical cardioversion is difficult even with antiarrhythmic drug therapy. Many investigators have tried to find out the factors determining the recurrence of AF after cardioversion and many potential predictors have been re- Lin/Lin/Lai/Tseng/Huang ported, including age [7,8], underlying heart disease [7][8][9], AF duration [10][11][12][13], left atrial size [14][15][16][17] and atrial electrical properties [18,19]. Nevertheless, fewer data exist regarding the predictors of recurrence after successful electrical cardioversion of chronic persistent AF lasting more than 3 months.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Clinical Recurrence after Successful Electrical Cardioversion of Chronic Persistent Atrial Fibrillation: Clinical and Electrophysiological Observations

Lin

Lai

et al. 2002

Cardiology

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Recurrence of atrial fibrillation (AF) after electrical cardioversion of chronic AF is not uncommon. However, it remains unclear which parameter(s) predict clinical recurrence. To assess the potential predictors of clinical recurrence after successful electrical cardioversion, we analyzed clinical, echocardiographic and electrophysiologic parameters in 36 patients (age 63 ± 11 years; 26 males, 10 females) with chronic persistent AF lasting more than 3 months. The dimensions of the left atrium and left ventricular end diastole and end systole were measured by echocardiography. The P wave characteristics from the surface 12-lead electrocardiogram (ECG) were studied in sinus rhythm. Atrial local activations were studied by biatrial basket electrode mapping in AF. With a mean of 7 ± 2 months of follow-up, 17 (47%) patients had AF recurrence despite multiple antiarrhythmic drug therapy. None of the clinical or echocardiographic parameters were relevant to the recurrence. However, among the surface ECG and intraatrial electrophysiological parameters, the mean P wave duration was the only independent predictor of the risk of clinical recurrence after successful electrical cardioversion. The sensitivity and predictive accuracy of recurrence were 82 and 70%, respectively, when the mean P wave duration was more than 125 ms.

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Maintenance of sinus rhythm after atrial defibrillation.

Cited by 68 publications

References 10 publications

Dynamic Nature of Atrial Fibrillation Substrate During Development and Reversal of Heart Failure in Dogs

Dynamic Nature of Atrial Fibrillation Substrate During Development and Reversal of Heart Failure in Dogs

Is there a place for the late cardioversion of atrial fibrillation?. A long-term follow-up study of patients with post-thyrotoxic atrial fibrillation

Predictors of Clinical Recurrence after Successful Electrical Cardioversion of Chronic Persistent Atrial Fibrillation: Clinical and Electrophysiological Observations

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