Clinical characteristics of patients with long-term episodes of persistent atrial fibrillation
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Abstract
The aim – to compare clinical, instrumental and laboratory characteristics of persistent atrial fibrillation (AF) patients with the duration of AF episode < 90 and ≥ 90 days.
Materials and methods. The cross-sectional study consecutively enrolled and analyzed clinical, instrumental and laboratory data from 118 persistent AF patients with the duration of its episode more than 7 days, who underwent an electrical cardioversion. Patients were subdivided into groups with the duration of AF episode 8-89 days (n=58) and ≥ 90 days (n=60).
Results and discussion. We observed a significant difference between the studied groups by the frequency of systolic dysfunction cases: 2 (3.5 %) vs. 12 (20.3 %) patients in AF episode duration < 90 and ≥ 90 days groups, respectively (p=0.008). According to transesophageal echocardiography data, we revealed the difference between the groups of comparison by the value of left atrial appendage flow velocity (43.5 cm/s vs. 37.0 cm/s, respectively; p=0.020). The difference between the studied groups by left atrial volume index did not reach the statistical significance (98 (80–110) vs. 99 (86–114) ml/m2, respectively; p=0.088). Besides, both studied groups were characterized by the prevalence of patients with moderate decrease of estimated glomerular filtration rate (eGFR) (60–89 mL/(min·1.73 m2)): 36 (62.1 %) cases in AF episode duration < 90 days, and 38 (63.3 %) – amongst patients with the duration ≥ 90 days. Furthermore, about one-third of patients in both studied groups presented with more pronounced eGFR decline (< 60 mL/(min·1.73 m2)): 16 (27.6 %) and 18 (30.0 %) cases in the groups with AF episode duration < 90 and ≥ 90 days, respectively.
Conclusions. The groups of persistent AF patients with the AF episode duration < 90 and ≥ 90 days were comparable by the majority of clinical, instrumental and laboratory characteristics, including the severity of kidney dysfunction. The AF episode duration ≥ 90 days was associated with the higher frequency of left ventricular systolic dysfunction cases, as well as with worse left atrial appendage function
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Дзяк Г.В., Жарінов О.Й. Фібриляція передсердь.– Київ: Четверта хвиля, 2011.– 192 с.
Benussi S., de Maat G. Atrial remodelling and function: implications for atrial fibrillation surgery // Eur. J. Cardio-Thoracic Surgery.– 2018.– Vol. 53 (Suppl. 1).– P. i2–i8. doi: 10.1093/ejcts/ezx340.
Calkins H., Hindricks G., Cappato R. et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation // Europace.– 2018.– Vol. 20 (1).– P. e1–e160. doi: 10.1093/europace/eux274.
De Vos C., Crijns H., Tieleman R. The fibrillating atrial myocardium visualized: an unexploited source of information // Heart Rhythm.– 2009.– Vol. 6 (8).– P. 1247–1248. doi: 10.1016/j.hrthm.2008.11.003.
Donghua Z., Jian P., Zhongbo X. et al. Reversal of cardiomyopathy in patients with congestive heart failure secondary to tachycardia // J. Interv. Card. Electrophysiol.– 2013.– Vol. 36 (1).– P. 27–32. doi: 10.1007/s10840-012-9727-9.
Dudink E., Erküner Ö., Berg J. et al. The influence of progression of atrial fibrillation on quality of life: a report from the Euro Heart Survey // EP Europace.– 2018.– Vol. 20 (6).– P. 929–934. doi: 10.1093/europace/eux217.
Fuster V., Rydén L., Cannom D. et al. ACC/AHA/ESC 2006 guidelines 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 European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) // J. Am. Coll. Cardiol.– 2006.– Vol. 48 (4).– P. e149–246. doi: 0.1161/CIRCULATIONAHA.106.177292.
Goette A., Kalman J., Aguinaga L. et al. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication // EP Europace.– 2016.– Vol. 18 (10).– P. 1455–1490. doi: 10.1093/europace/euw161.
Hindricks G., Potpara Т., Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC // Eur. Heart J.– 2020.– Vol. 42 (5).– P. 373–498. doi:10.1093/eurheartj/ehaa612.
January C., Wann L., Alpert J. et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society // Circulation.– 2014.– Vol. 130 (23).– P. e2071–e2104. doi: 10.1161/CIR.0000000000000040.
Kirchhof P., Camm A., Goette A. et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation // New Engl. J. Med.– 2020.– Vol. 383.– P. 1305–1316. doi: 10.1056/NEJMoa2019422.
Konrad T., Theis, C., Mollnau H. et al. Primary Persistent Atrial Fibrillation: A Distinct Arrhythmia Subentity of an Ablation Population // J. Cardiovasc. Electrophysiol.– 2015.– Vol. 26 (12).– P. 1289–1294. doi: 10.1111/jce.12818.
Kotecha D., Piccini J. Atrial fibrillation in heart failure: what should we do? // Eur. Heart J.– 2015.– Vol. 36 (46).– P. 3250–3257. doi: 10.1093/eurheartj/ehv513.
Kottkamp H., Schreiber D. The Substrate in «Early Persistent» Atrial Fibrillation: Arrhythmia Induced, Risk Factor Induced, or From a Specific Fibrotic Atrial Cardiomyopathy? // JACC: Clinical Electrophysiology.– 2016.– Vol. 2 (2).– P. 140–142. doi: 10.1016/j.jacep.2016.02.010.
Lim H., Denis A., Middeldorp M. et al. Persistent Atrial Fibrillation From the Onset: A Specific Subgroup of Patients With Biatrial Substrate Involvement and Poorer Clinical Outcome // JACC: Clinical Electrophysiology.– 2016.– Vol. 2 (2).– P. 129–139. doi: 10.1016/j.jacep.2016.02.010.
Limantoro I., de Vos C., Delhaas T. et al. Clinical correlates of echocardiographic tissue velocity imaging abnormalities of the left atrial wall during atrial fibrillation // Europace.– 2014.– Vol. 16 (11).– P. 1546–1553. doi: 10.1093/europace/euu047.
Steffel J., Collins R., Antz M. et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation // EP Europace.– 2021.– euab065. doi: 10.1093/europace/euab065.
Stevens P., Levin A. Kidney Disease: Improving Global Outcomes (KDIGO) СKD Work Group. KDIGO 2012. Clinical Practice Guideline for the for the Evaluation and Management of Chronic Kidney Disease // Kidney int.– 2013.– Vol. 3 (Suppl).– P. 1–150. doi: 10.7326/0003-4819-158-11-201306040-00007.
Thomas L., Abhayaratna W. Left Atrial Reverse Remodeling: Mechanisms, Evaluation, and Clinical Significance // JACC: Cardiovascular Imaging.– 2017.– Vol. 10 (1).– P. 65–77. doi: 10.1016/j.jcmg.2016.11.003.
Wałek P., Sielski J., Gorczyca I. et al. Left atrial mechanical remodelling assessed as the velocity of left atrium appendage wall motion during atrial fibrillation is associated with maintenance of sinus rhythm after electrical cardioversion in patients with persistent atrial fibrillation // PLoS One.– 2020.– Vol. 15 (1).– P. 228–239. doi: 10.1371/journal.pone.0228239.