FACTORS INFLUENCING LONG-TERM PERSISTENCE OF SINUS RHYTHM AFTER A FIRST ELECTRICAL CARDIOVERSION FOR ATRIAL-FIBRILLATION

If is conventionally thought that electrical cardioversion in patients with atrial fibrillation (AF) of longstanding duration or with a larg e left atrial diameter only seldom results in long term success. Recur rence is common, although antiarrhythmic drugs often effectively decre ase the number and duration of recurrent AF episodes. We analysed clin ical, functional and pharmacological variables which could possibly in fluence the long term outcome after a first electrical cardioversion f or AF in a retrospective study on 85 patients. Univariate and multivar iate analysis was used to identify factors predicting maintenance of s inus rhythm at 100 days, and absence of recurrence during the entire f ollow-up. In univariate analysis, the only significant predictor for m aintenance of sinus rhythm at 100 days was the duration of the precedi ng AF episode. Multivariate analysis with persistence of sinus rhythm at 100 days as endpoint confirmed this as a prognostic factor (p < 0.0 3), but sotalol treatment also contributed to maintenance of signals r hythm (p < 0.05). When considering the entire observation period, clas s III antiarrhythmic drugs, i.e. sotalol and amiodarone, were useful i n preventing recurrence (p < 0.01 and < 0.02). High age (above 75 year s) was a predictor of recurrence. In conclusion, class III antiarrhyth mic drugs, the duration of atrial fibrillation and high age were the m ost important determinants of long term outcome, while echocardiograph ic parameters and the presence of heart disease played no role.