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Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation
M A Brodsky1, B J Allen, E V Capparelli
1Department of Medicine, University of California at Irvine, Orange 92668.
Insights
Maintaining sinus rhythm after atrial fibrillation (AF) conversion is often successful in patients with moderate left atrial dilatation and short-term AF, particularly with pharmacologic therapy alone.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Successful therapy for atrial fibrillation (AF) depends on multiple patient and disease factors.
- Left atrial (LA) size is a key consideration in AF management and rhythm control.
Purpose of the Study:
- To identify factors associated with maintaining sinus rhythm after conversion in patients with chronic AF and dilated left atria.
- To evaluate the long-term efficacy of pharmacologic therapy in rhythm control for AF patients.
Main Methods:
- A cohort of 43 patients with symptomatic chronic AF and LA dimension >= 45 mm were followed for at least 6 months post-conversion.
- Patients received antiarrhythmic drug therapy (Class IA, IC, or amiodarone).
- Life table analysis was used to assess the duration of maintained sinus rhythm.
Main Results:
- Sinus rhythm was maintained in 81% at 6 months, 79% at 12 months, and 60% at 24 months.
- Positive predictors for rhythm maintenance included conversion with drugs alone, chronic AF duration <= 1 year, absence of mitral valve disease, and LA dimension <= 60 mm.
- Patient age, left ventricular function, and coronary disease did not significantly impact outcomes.
Conclusions:
- Patients with moderate left atrial dilatation (45-60 mm) and AF duration of 1 year or less can often maintain sinus rhythm.
- Pharmacologic intervention alone is effective for rhythm control in selected AF patients.
- LA size and AF duration are critical factors in predicting successful rhythm maintenance after AF conversion.
Abstract:
Successful therapy of atrial fibrillation (AF) has been reportedly influenced by a variety of factors including patient age, type of underlying heart disease, duration of arrhythmia, left ventricular function and left atrial (LA) size. To determine which of these factors are associated with maintenance of sinus rhythm after conversion, 43 patients with symptomatic chronic AF in the setting of a dilated left atrium (greater than or equal to 45 mm, range 45 to 78) were followed for at least 6 months after the return of sinus rhythm. Class IA drugs, IC drugs or amiodarone were used for therapy. Life table analysis showed sinus rhythm to be maintained in 81% for 6 months, 79% for 12 months and 60% for 24 months. Factors positively associated with success were conversion with drug therapy alone, duration of chronic AF less than or equal to 1 year, absence of mitral valve disease and LA dimension less than or equal to 60 mm (all p less than 0.05). Patient age, left ventricular function and presence of coronary disease were not associated with outcome. Thus, patients with moderate LA dilatation (45 to 60 mm) and a short duration of chronic AF can often be maintained in sinus rhythm, especially if they convert with pharmacologic intervention alone.