Predictors of early recurrence of arrhythmia among patients with nonvalvular persistent atrial fibrillation and flutter after cardioversion

Main Article Content

U. P. Chernyaha-Royko
O. J. Zharinov
N. S. Pavlyk
S. S. Pavlyk


The aim – to compare clinical and morphofunctional characteristics of patients with nonvalvular persistent atrial fibrillation and flutter (AF and AFL) with and without early arrhythmia recurrence after cardioversion.
Material and methods. One hundred and fifty patients with documented persistent AF/AFL, who underwent successful cardioversion during hospitalization period, were involved in the prospective one-center study. Scheduled registration of ECG, continuous Holter ECG monitoring and event monitoring within 7 days were performed to identify AF/AFL recurrences. Demographic, clinical and functional characteristics, concomitant diseases, treatments were compared in groups of patients with (n=50) and without (n=100) early recurrence of atrial fibrillation after cardioversion.
Results. Isolated AF occurred more often in patients without AF/AFL recurrences (Р=0.00116); AF was more often combined with different types of AFL in patients with arrhythmia recurrent episodes (Р=0.001). Patients with AF/AFL recurrences had longer duration of arrythmia history (Р=0.00048) and also tendency towards longer duration of last
AF/AFL episode (Р=0.077). Patients with AF/AFL recurrences had lower daily average and minimum heart rate, larger amount of supraventricular extrasystoles (Р=0.0001), couplets (Р=0.00002) and groups (Р=0.0001) during 24-hour Holter ECG monitoring. There were more paroxysms of atrial tachycardia (Р=0.0019) in patients with AF/AFL recurrences as well.
Conclusions. Recurrent episodes of AF/AFL during hospitalization occur in one third of the patients after successful electrical or chemical cardioversion. The 24-hour Holter monitoring of ECG and event monitoring raises possibility to detect rhythm disorder at early stages after cardioversion. Presence of AFL, detection of frequent supraventricular extrasystoles, couplets and groups and short paroxysms of atrial tachyarrhythmia could be strong predictors of AF/AFL early recurrence.

Article Details


atrial fibrillation, atrial flutter, persistent form, predictors of recurrence, asymptomatic episodes, event monitoring


Наказ МОЗ України від 15.06.2016 № 597 «Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги (УКПМД) «Фібриляція передсердь».– 2016.– С. 82.

Arrigo M., Jaeger N., Seifert B. et. al. Disappointing Success of Electrical Cardioversion for New-Onset Atrial Fibrillation in Cardiosurgical ICU Patients // Crit. Care. Med.– 2015.– Vol. 43 (11).– P. 2354–2359.

Benezet-Mazuecos J., Rubio J.M., Farré J. Atrial high rate episodes in patients with dual-chamber cardiac implantable electronic devices: unmasking silent atrial fibrillation // Pacing Clin. Electrophysiol.– 2014.– Vol. 37 (8).– Р. 1080–1086.

Bhandari A.K., Anderson J.L., Gilbert E.M. et al. The Flecainide Supraventricular Tachycardia Study Group. Correlation of symptoms with the occurrence of paroxysmal supraventricular tachycardia or atrial fibrillation: a transtelephonic monitoring study // Am. Heart J.– 1992.– Vol. 124 (2).– Р. 381–386.

Boriani G., Diemberger I., Ziacchi M. et al. AF burden is important – fact or fiction? // Int. J. Clin. Pract.– 2014.– Vol. 68 (4).– Р. 444–452.

Boriani G., Valzania C., Biffi M. et al. Asymptomatic Lone Atrial Fibrillation – How Can We Detect The Arrhythmia? // Curr. Pharm. Des.– 2015.– Vol. 21 (5).– P. 659–666.

Disertori M., Lombardi F., Barlera S. еt al. Clinical characteristics of patients with asymptomatic recurrences of atrial fibrillation in the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-Atrial Fibrillation (GISSI-AF) trial // Am. Heart J.– 2010.– Vol. 159 (5).– P. 857–863.

Eitel C., Hindricks G., Piorkowski C. et al. Atrial fibrillation. New aspects for diagnosis and follow-up // Herzschrittmacherther Elektrophysiol.– 2009.– Vol. 20 (4).– P. 173–178.

Ferreira J.P., Santos M. Heart failure and atrial fibrillation: from basic science to clinical practice // Int. J. Mol. Sci.– 2015.– Vol. 16 (2).– P. 3133–3147.

Fetsch Т., Bauer P., Engberding R. et al. Prevention of artrial fibrillation after cardioversion: results of the PAFAC trial // Eur. Heart J.– 2004.– Vol. 25.– Р. 1385–1394.

Flaker G.C., Belew K., Beckman K. et al. Asymptomatic arial fibrillation: demographic features and prognostic information from the Atrial fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study // Am. Heart J.– 2005.– Vol. 149 (4).– P. 657–663.

Frost L., Mølgaard H., Christiansen E.H. et al. Low vagal tone and supraventricular ectopic activity predict atrial fibrillation and flutter after coronary artery bypass grafting // Eur. Heart. J.– 1995.– Vol. 16 (6).– P. 825–831.

Gang U.J., Nalliah C.J., Lim T.W. et al. Atrial Ectopy Predicts Late Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation // Circ Arrhythm Electrophysiol.– 2015.– Vol. 8 (3).– P. 569–574.

Ito Y., Yamasaki H., Naruse Y. еt al. Effect of eplerenone on maintenance of sinus rhythm after catheter ablation in patients with long-standing persistent atrial fibrillation // Am. J. Cardiol.– 2013.– Vol. 111 (7).– P. 1012–1018.

Kirchhof P., Benussi S., Kotecha D. et аl. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS // Eur. Heart J.– 2016.– Vol. 37 (38).– P. 2893–2962.

Kotecha D., Piccini J.P. Atrial fibrillation in heart failure: what should we do? // Eur. Heart J.– 2015.– Vol. 36 (46).– P. 3250–3257.

Kowalik I., Dąbrowski R., Borowiec A. еt al. Combined hypotensive treatment with ≥ 3 hypotensive drugs in patients with recurrent atrial fibrillation and arterial hypertension ensures more effective arrhythmia control than using less drugs // Kardiol. Pol.– 2012.– Vol. 70 (7).– Р. 659–666.

Kruse M.L., Kruse J.C., Leiria T.L. et al. Relationship between silent atrial fibrillation and the maximum heart rate in the 24-hour Holter: cross-sectional study // Sao. Paulo. Med. J.– 2014.– Vol. 132 (6).– Р. 359–363.

Miyazaki S., Taniguchi H., Nakamura H. et al. Clinical significance of early recurrence after pulmonary vein antrum isolation in paroxysmal atrial fibrillation – insight into the mechanism // Circ. J.– 2015.– Vol. 79 (11).– P. 2353–2359.

Müller P., Schiedat F., Dietrich J.W. et al. Reverse atrial remodeling in patients who maintain sinus rhythm after electrical cardioversion: evidence derived from the measurement of total atrial conduction time assessed by PA-TDI interval // J. Echocardiogr.– 2014.– Vol. 12 (4).– P. 142–150.

Patten M., Maas R., Bauer P. et al. Suppression of paroxysmal atrial tachyarrhythmias: results of SOPAT trial // Eur. Heart J.– 2004.– Vol. 25.– Р. 1395–1404.

Swiryn S., Orlov M., Benditt D. Clinical implications of brief device-det ected atrial tachyarrythmias in a cardiac rhythm management device population. Results from the registry of atrial tachycardia and atrial fibrillation episodes // Circulation.– 2016.– Vol. 134.– P. 1130–1140.

Yoon J.H., Moon J., Chung Hm. et al. Left atrial function assessed by Doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation // Clin. Cardiol.– 2013.– Vol. 36 (4).– P. 235–240.

Most read articles by the same author(s)

1 2 > >>