Lviv clinical bulletin 2014, 4(8): 8-13

https://doi.org/10.25040/lkv2014.04.008

Predicting of Long-term Maintenance of Sinus Rhythm after Cardioversion in Patients with Nonvalvular Persistent Atrial Fibrillation

Posted onAuthorAdminЗалишити коментар / Leave a comment

О. Zharinov1, N. Levchuk2, М. Ikorkin2, О. Sychov2

1Shupyk National Medical Academy of Postgraduate Education

2National Scientific Center “M.D. Strazhesko Institute of Cardiology” MAS of Ukraine

Introduction. The choice of the optimal strategy for conducting the patients with persistent atrial fibrillation (AF) and the expediency of prolonged antiarrhythmic treatment after cardioversion is highly dependent on the probability of relapse of arrhythmia. The basis of the clinical systematization of paroxysms of AF and one of the most important elements of the algorithm for the management of patients is the criterion of the frequency of episodes of arrhythmia. The processes of fibrosis, electrical perturbation of the atrium and the creation of conditions for circular circulation of the excitation influence a lot on the course and the possibility of the AF persistence.

The aim of the study was to determine the role of clinical anamnesis, demographic and a number of indicators of the structural and functional status of the left heart units to predict the conservation of sinus rhythm in patients with persistent AF for 18 months after the cardioversion.

Materials and methods. The study included 225 patients (178 men and 47 women), aged 34–79 years, chosen for planned cardioversion. General clinical investigation, ECG, transthoracic and transesophageal echocardiography for detailed evaluation of structure and function of atria and ventricles were performed in all patients. After cardioversion the follow-up investigations were performed every 6 months. In order to restore the sinus rhythm individually, amiodarone, propafenone, etazysin, or their combination with β-blockers, according to the existing recommendations on their application, were used. In 128 cases (56.9 %) an electrical cardioversion was performed to restore the sinus rhythm of the heart.

Results. In total, after 18 months the sinus rhythm was maintained in 125 (55.6 %) patients. At the same time, persistent or permanent AF was registered in 100 patients (44.4 %). The age of patients, duration of the disease, heart rate and some left heart structural and functional parameters had independent role for predicting the sinus rhythm maintenance. I.e., left atrium diameter < 45 mm, index of left atrium volume < 50 ml/m2, left ventricular end-diastolic volume < 145 ml, average left atrium appendage ejection velocity ≥ 30 cm/s, absence of spontaneous contrast phenomenon were predictors of the long-term sinus rhythm maintenance.

Conclusions. The obtained model is characterized by the high sensitivity, specificity and diagnostic value in the prognosis of maintaining the sinus rhythm of the heart in case of AF.

References

  1. Dzyak HV, Zharinov OY. Atrial Fibrillation. Kyiv: Chetwerta hvylya, 2011. 192 p. (Ukrainian)
  2. Sychov OS, Kovalenko VM, Dzyak HV et al. Diagnosis and Treatment of Atrial Fibrillation. Recommendations of the Working Group on Cardiac Rhythm Disorders of the Association of Cardiologists of Ukraine. 2012;1:5-88. (Ukrainian)
  3. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719-2747.
  4. January CT, Wann, LS, Alpert, JS, Calkins H, Cigarroa JE, Cleveland JC et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: Executive summary: A report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society. J Am Coll Cardiol. 2014;64(21):2245-2280. https://doi.org/10.1016/j.jacc.2014.03.021
  5. Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA et al. Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation. 1990;82(3):792-797. https://doi.org/10.1161/01.CIR.82.3.792
  6. Lévy S, Breithardt G, Campbell RW, Camm AJ, Daubert JC, Allessie M et al. Atrial fibrillation: current knowledge and recommendations for management. Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J. 1998;19(9):1294-1320.
  7. Leung DY, Boyd A, Ng AA, Chi C, Thomas L. Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J. 2008;156(6):1056-1064. https://doi.org/10.1016/j.ahj.2008.07.021
  8. Steg PG, Alam S, Chiang CE, Gamra H, Goethals M, Inoue H et al. On behalf of the RealiseAF Investigators. Symptoms, functional status and quality of life in patients with controlled and uncontrolled atrial fibrillation: data from the RealiseAF cross-sectional international registry. Heart. 2012;98(3):195-201. https://doi.org/10.1136/heartjnl-2011-300550
  9. Fatkin D, Kelly RP, Feneley MP. Relations between LAA blood flow velocity, spontaneous echocardiographic contrast (SEC) and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. https://doi.org/10.1016/0735-1097(94)90644-0
  10. Corley SD, Epstein AE, DiMarco JP, Domanski MJ, Geller N, Greene HL et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 2004;109(12):1509-1513. https://doi.org/10.1161/01.CIR.0000121736.16643.11
  11. Bashir M, Asher CR, Garcia MJ, Abdalla I, Jasper SE, Murray RD et al. Right atrial spontaneous echo contrast and thrombi in atrial fibrillation: a transesophageal echocardiography study. J Am Soc Echocardiogr. 2001;14(2):1256-1259. https://doi.org/10.1067/mje.2001.108668
  12. Shaikh AY, Maan A, Khan UA, Aurigemma GP, Hill JC, Kane JL et al. Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation. Cardiovasc Ultrasound. 2012;10:48. https://doi.org/10.1186/1476-7120-10-48
  13. Smit MD, Moes ML, Maass AH, Achekar ID, Van Geel PP, Hillege HL et al. The importance of whether atrial fibrillation or heart failure develops first. Eur J Heart Fail. 2012;14(9):1030-1040. https://doi.org/10.1093/eurjhf/hfs097
  14. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al. The Task Force for the management of atrial fibrillation of the European Society of Cardiology. Guidelines for the management of atrial fibrillation. Eur Heart J. 2010;31(19):2369-2429. https://doi.org/10.1093/eurheartj/ehq278