Spontaneous Reversion from Long‐Lasting Atrial Fibrillation to Sinus Rhythm

Abstract

We have collected 23 cases with atrial fibrillation (AF) of 3-29 years' duration with spontaneous reversion to sinus rhythm (SR). We have also identified 22 similar cases in the literature. Several of our patients spent several years with different atrial arrhythmias before a stable SR was established. Of all the 45 cases, 39 had significant rheumatic mitral valve disease. In the majority of these patients the ECG shows first degree AV block after return to SR and a low-amplitude P-wave-as if the left atrial P component was lacking. There are no signs of left atrial mechanical activity after re-establishment of SR in our mitral valve disease group, as judged from phonocardiograms, apexcardiograms, echocardiograms and left atrial pressure recordings in selected patients. Heart muscle biopsy was obtained from two patients who underwent mitral valve surgery. Left atrial specimens showed almost complete lack of all muscle structures. There is thus electrical, mechanical and histological evidence of left atrial muscle deterioration. It is likely that the electrophysiological factors responsible for initiation and maintenance of AF have disappeared with this deterioration, thereby allowing SR to be re-established.The return of SR might indicate a progress of the heart disease although the patient may benefit from normalization of cardiac rate and regularity. The easy identification of our 23 patients makes us believe that the phenomenon of appearance of late SR is far more common than suggested up to now.

Pitfalls in rate and rhythm control: Severe concomitant orthostatic hypotension unmasks after conversion to sinus rhythm

“…Previous publications postulate that spontaneous termination of long-lasting AFib predicts poor prognosis as it usually manifests progression of underlying heart disease and represents almost complete substitution of left atrial myocardium by fi brous tissue and frequently associated with severe AV and intraventricular conduction disturbances [6]. However, there are reports of spontaneous sinus rhythm restoration with preserved mechanical atrial function as indirect benefi cial result of therapeutic interventions [7].…”

Atrial Fibrillation—Some Current Problems

“…The possibility of spontaneous reversion from longlasting atrial fibrillation to sinus rhythm is pointed out in this issue of the Acta Medica Scandinavica (16). A majority of the patients who have undergone such an unexpected development of their arrhythmia suffered from advanced rheumatic mitral valve disease.…”