Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation
M. Frick et al., Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation, CLIN CARD, 24(3), 2001, pp. 238-244
Background: The recurrence rate of atrial fibrillation (AF) after elective
cardioversion is high.
Hypothesis: The study aimed to identify clinical predictors for successful
electrical cardioversion and maintenance of sinus rhythm after a first elec
trical cardioversion in patients with persistent AF without concomitant ant
iarrhythmic drugs of class I and LII.
Methods: Consecutive outpatients (n = 166) with persistent AF for > 1 month
, scheduled for elective cardioversion, were prospectively included in the
study. A clinical investigation, echocardiographic assay, and Kelter electr
ocardiogram (ECG) before and ECG 4 weeks after cardioversion, were performe
d in all patients.
Results: The mean age of the patients was 68 years (range 45-83) and durati
on of AF was 5 (1-48) months. Sinus rhythm was established in 124 (75%) pat
ients. In multivariate analysis, only duration of AF < 6 months (p < 0.04,
odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1 to 4.7) and patients
weight (p <0.03, OR 2.3, 95% CI 1.1 to 4.8 for weight < 80 kg) were identif
ied as independent predictors of successful cardioversion. At 4 weeks after
cardioversion, only 46 (37%) of 124 patients maintained sinus rhythm. Inde
pendent factors for maintenance of sinus rhythm, in multivariate analysis,
were AF <3 months (p<0.04, OR 2.5, 95% CI 1.1 to 5.6), treatment with beta
blockers (p < 0.00001, OR 7.0, 95% CI 3.0 to 16.3) or verapamil/diltiazem (
p<0.04, OR 3.6, 95% CI 1.1 to 12.1), and right atrial dimension < 37 mm (p
< 0.02, OR 5.9, 95% CI 1.4 to 25.4).
Conclusions: In patients with persistent AF, the patient's weight and the d
uration of AF are independent predictors for a successful cardioversion. Sh
ort duration of AF, treatment with beta blockers or verapamil/diltiazem, an
d right atrial area/dimension are independent predictors for maintenance of
sinus rhythm.