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Factors influencing long term persistence of sinus rhythm after a first electrical cardioversion for atrial
M Duytschaever1, F Haerynck, R Tavernier
1Department of Cardiology, University Hospital Ghent, Belgium.
Insights
Long-term success after electrical cardioversion for atrial fibrillation (AF) depends on AF duration and age. Class III antiarrhythmic drugs like sotalol and amiodarone significantly improve outcomes and prevent recurrence.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Electrical cardioversion is a common treatment for atrial fibrillation (AF).
- Long-term success rates are often limited, particularly in patients with longstanding AF or large left atrial diameter.
- Recurrence of AF is frequent, though antiarrhythmic drugs can mitigate episode frequency and duration.
Purpose of the Study:
- To identify clinical, functional, and pharmacological factors influencing long-term success after a first electrical cardioversion for AF.
- To determine predictors for maintaining sinus rhythm at 100 days and preventing recurrence throughout follow-up.
Main Methods:
- Retrospective study involving 85 patients undergoing their first electrical cardioversion for AF.
- Univariate and multivariate analyses were employed to assess prognostic factors.
- Endpoints included maintenance of sinus rhythm at 100 days and absence of recurrence during the entire follow-up period.
Main Results:
- The duration of the preceding atrial fibrillation episode was a significant predictor for maintaining sinus rhythm at 100 days (p < 0.03).
- Treatment with sotalol also contributed to sinus rhythm maintenance (p < 0.05).
- Class III antiarrhythmic drugs (sotalol, amiodarone) were effective in preventing recurrence (p < 0.01 and < 0.02). High age (above 75 years) predicted recurrence.
Conclusions:
- Class III antiarrhythmic drugs, duration of atrial fibrillation, and advanced age are key determinants of long-term outcomes after electrical cardioversion.
- Echocardiographic parameters and the presence of heart disease did not play a significant role in long-term success.
Abstract:
It is conventionally thought that electrical cardioversion in patients with atrial fibrillation (AF) of longstanding duration or with a large left atrial diameter, only seldom results in long term success. Recurrence is common, although antiarrhythmic drugs often effectively decrease the number and duration of recurrent AF episodes. We analysed clinical, functional and pharmacological variables which could possibly influence the long term outcome after a first electrical cardioversion for AF in a retrospective study on 85 patients. Univariate and multivariate analysis was used to identify factors predicting maintenance of sinus rhythm at 100 days, and absence of recurrence during the entire follow-up. In univariate analysis, the only significant predictor for maintenance of sinus rhythm at 100 days was the duration of the preceding AF episode. Multivariate analysis with persistence of sinus rhythm at 100 days as endpoint confirmed this as a prognostic factor (p < 0.03), but sotalol treatment also contributed to maintenance of sinus rhythm (p < 0.05). When considering the entire observation period, class III antiarrhythmic drugs, i.e. sotalol and amiodarone, were useful in preventing recurrence (p < 0.01 and < 0.02). High age (above 75 years) was a predictor of recurrence. In conclusion, class III antiarrhythmic drugs, the duration of atrial fibrillation and high age were the most important determinants of long term outcome, while echocardiographic parameters and the presence of heart disease played no role.