Predictors of sinus rhythm maintenance in patients with late persistent atrial fibrillation at 6-months follow-up after direct current cardioversion
Article Sidebar
This work is licensed under a Creative Commons Attribution 4.0 International License.
Main Article Content
https://orcid.org/0000-0002-4443-3137
Abstract
The aim – to study the predictors of sinus rhythm (SR) maintenance in patients with persistent atrial fibrillation (AF) and duration of AF episode ≥90 days at 6-months follow-up after elective direct current (DC) cardioversion.
Materials and methods. The cohort single-center study analyzed clinical and instrumental data from 59 persistent AF patients with duration of its episode ≥90 days (up to 12 months), who underwent an elective DC cardioversion. At 6-months follow-up, patients were subdivided into the groups depending on SR maintenance: 32 (54 %) patients with a maintained SR (G1), and 27 (46 %) patients with a failure to maintain SR (G2).
Results. G2, as compared to G1, demonstrated more advanced heart failure (stage C occurred in 74 % and 44 %, respectively [p=0,019]). According to transthoracic echocardiography (TTE) data, G1, as opposed to G2, was characterized by better baseline structure parameters of left heart chambers, particularly the diameter of left atrium (LA), end-diastolic and end-systolic volumes left ventricular (LV) volumes, higher LV systolic function (by LV ejection fraction [EF]), and the majority of the cases without or with mild pulmonary hypertension (PH). Transesophageal echocardiography data suggested the cases of LA spontaneous (echo) contrast and LA appendage flow velocity (LAAFV) ≤ 40 cm/s to be more frequent in G2, in contrast to G1. We revealed the following predictors of SR maintenance after DC cardioversion at 6-months follow-up: higher LV EF (OR 1,07 (95 % CI 1,01–1,13); р=0,021); LAAFV > 40 cm/s (OR 4,33 (95 % CI 1,06–17,78); р=0,042), and less advanced PH (OR 0,24 (95 % CI 0,06–0,93); р=0,038). TTE data from G1 at 6-months follow-up after DC cardioversion suggested the reverse remodeling of both atria (the decrease of LA diameter, LA and right atrium volumes and their indexes). Additionally, G2 demonstrated a worsening in LV systolic function (the rise of LV end-systolic volume and decrease of LV EF), as opposed to G1. Moreover, at 6-months follow-up, G2 patients presented with more advanced severity of PH, as well as mitral and tricuspid regurgitation, in contrast to G1.
Conclusions. Better LV systolic function, LAAFV > 40 cm/s and less advanced PH were the predictors of SR maintenance in patients with persistent AF and duration of its episode ≥ 90 days at 6-months follow-up after elective DC cardioversion. The SR maintenance at 6-months follow-up associated with the reverse remodeling of let heart chambers and right atrium. On the contrary, a failure to maintain SR associated with the decrease of LV systolic function, and more advanced PH, mitral and tricuspid regurgitation.
Article Details
Keywords:
References
Ahmed S, Rienstra M, Crijns HJ, Links TP, Wiesfeld AC, Hillege HL, Bosker HA, Lok DJ, Van Veldhuisen DJ, Van Gelder IC; CONVERT Investigators. Continuous vs episodic prophylactic treatment with amiodarone for the prevention of atrial fibrillation: a randomized trial. JAMA. 2008;300(15):1784-92. https://doi.org/10.1001/jama.300.15.1784.
Akamatsu K, Ito T, Ozeki M, Miyamura M, Sohmiya K, Hoshiga M. Left atrial spontaneous echo contrast occurring in patients with low CHADS2 or CHA2DS2-VASc scores. Cardiovasc Ultrasound. 2020;18(1):31. https://doi.org/10.1186/s12947-020-00213-2.
Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54(2):230-46. https://doi.org/10.1016/s0008-6363(02)00258-4.
Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res. 2014;114(9):1453-68. https://doi.org/10.1161/CIRCRESAHA.114.303211.
Beppu S, Nimura Y, Sakakibara H, Nagata S, Park YD, Izumi S. Smoke-like echo in the left atrial cavity in mitral valve disease: its features and significance. J Am Coll Cardiol. 1985;6(4):744-9. https://doi.org/10.1016/s0735-1097(85)80476-9.
Brandes A, Crijns HJGM, Rienstra M, Kirchhof P, Grove EL, Pedersen KB, Van Gelder IC. Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure. Europace. 2020;22(8):1149-61. https://doi.org/10.1093/europace/euaa057.
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d'Avila A, Natasja de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T; Document Reviewers: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1-e160. https://doi.org/10.1093/europace/eux274.
Camm AJ, Naccarelli GV, Mittal S, Crijns HJGM, Hohnloser SH, Ma CS, Natale A, Turakhia MP, Kirchhof P. The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022;79(19):1932-48. https://doi.org/10.1016/j.jacc.2022.03.337.
Charalampopoulos A, Lewis R, Hickey P, Durrington C, Elliot C, Condliffe R, Sabroe I, Kiely DG. Pathophysiology and Diagnosis of Pulmonary Hypertension Due to Left Heart Disease. Front Med (Lausanne). 2018;5:174. https://doi.org/10.3389/fmed.2018.00174.
De Vos CB, Crijns HJ, Tieleman RG. The fibrillating atrial myocardium visualized: an unexploited source of information. Heart Rhythm. 2009;6(8):124748. https://doi.org/10.1016/j.hrthm.2008.11.003.
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 Guidelines 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 European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114(7):e257-354. https://doi.org/10.1161/CIRCULATIONAHA.106.177292. Erratum in: Circulation. 2007;116(6):e138.
Gumprecht J, Szulik M, Domek M, Mazurek M, Shantsila A, Oxborough D, Lip G. Novel Echocardiographic Biomarkers in the Management of Atrial Fibrillation. Current Cardiovascular Imaging Reports. 2019;12(43):1-12. https://doi.org/10.1007/s12410-019-9520-6.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW; WRITING COMMITTEE MEMBERS. 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guideline for the Management of Heart Failure: Executive Summary. J Card Fail. 2022;28(5):810-30. https://doi.org/10.1016/j.cardfail.2022.02.009.
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 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. 2021;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612. Erratum in: Eur Heart J. 2021;42(5):507. Erratum in: Eur Heart J. 2021;42(5):546-547. Erratum in: Eur Heart J. 2021;42(40):4194.
Konrad T, Theis C, Mollnau H, Sonnenschein S, Ocete BQ, Bock K, Münzel T, Rostock T. Primary Persistent Atrial Fibrillation: A Distinct Arrhythmia Subentity of an Ablation Population. J Cardiovasc Electrophysiol. 2015;26(12):1289-94. https://doi.org/10.1111/jce.12818.
Kottkamp H, Bender R, Berg J. Catheter ablation of atrial fibrillation: how to modify the substrate? J Am Coll Cardiol. 2015;65(2):196-206. https://doi.org/10.1016/j.jacc.2014.10.034.
Lim HS, Denis A, Middeldorp ME, Lau DH, Mahajan R, Derval N, Albenque JP, Boveda S, Zellerhoff S, Yamashita S, Berte B, Mahida S, Komatsu Y, Daly M, Jesel L, Pomier C, Meillet V, Dubois R, Amraoui S, Shah A, Sacher F, Cochet H, Hocini M, Jaïs P, Sanders P, Haïssaguerre M. Persistent Atrial Fibrillation From the Onset: A Specific Subgroup of Patients With Biatrial Substrate Involvement and Poorer Clinical Outcome. JACC Clin Electrophysiol. 2016;2(2):129-39. https://doi.org/10.1016/j.jacep.2015.12.014.
Limantoro I, de Vos CB, Delhaas T, Weijs B, Blaauw Y, Schotten U, Kietselaer B, Pisters R, Crijns HJ. Clinical correlates of echocardiographic tissue velocity imaging abnormalities of the left atrial wall during atrial fibrillation. Europace. 2014;16(11):1546-53. https://doi.org/10.1093/europace/euu047.
Lohvinov YM, Mikhaliev KO, Zharinov OJ. Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation. Kardiol Pol. 2015;73(9):701-10. https://doi.org/10.5603/KP.2015.0162.
Magnocavallo M, Parlavecchio A, Vetta G, Gianni C, Polselli M, De Vuono F, Pannone L, Mohanty S, Cauti FM, Caminiti R, Miraglia V, Monaco C, Chierchia GB, Rossi P, Di Biase L, Bianchi S, de Asmundis C, Natale A, Della Rocca DG. Catheter Ablation versus Medical Therapy of Atrial Fibrillation in Patients with Heart Failure: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2022;11(19):5530. https://doi.org/10.3390/jcm11195530.
Marwick TH, Brugger N. Effects of Atrial Fibrillation and Sinus Rhythm on Cardiac Remodeling and Valvular Regurgitation. J Am Coll Cardiol. 2022;79(10):962-964. https://doi.org/10.1016/j.jacc.2021.12.028.
Miyazaki S, Ito T, Suwa M, Nakamura T, Kobashi A, Kitaura Y. Role of transesophageal echocardiography in the prediction of thromboembolism in patients with chronic nonvalvular atrial fibrillation. Jpn Circ J. 2001;65(10):874-8. https://doi.org/10.1253/jcj.65.874.
Mont L, Bisbal F, Hernández-Madrid A, Pérez-Castellano N, Viñolas X, Arenal A, Arribas F, Fernández-Lozano I, Bodegas A, Cobos A, Matía R, Pérez-Villacastín J, Guerra JM, Ávila P, López-Gil M, Castro V, Arana JI, Brugada J; SARA investigators. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014;35(8):501-7. https://doi.org/10.1093/eurheartj/eht457.
Montgomery JA, Michaud GF. Ablation of Persistent and Long-standing Persistent Atrial Fibrillation. In book: Catheter Ablation of Cardiac Arrhythmias; 4th Ed. SK. Stephen Huang, JM. Miller (Eds). Elsevier, 2019:292-304.e4. doi:10.1016/B978-0-323-52992-1.00019-3.
Reddy YNV, Borlaug BA. Pulmonary Hypertension in Left Heart Disease. Clin Chest Med. 2021;42(1):39-58. https://doi.org/10.1016/j.ccm.2020.11.002.
Schotten U, Ausma J, Stellbrink C, Sabatschus I, Vogel M, Frechen D, Schoendube F, Hanrath P, Allessie MA. Cellular mechanisms of depressed atrial contractility in patients with chronic atrial fibrillation. Circulation. 2001;103(5):691-8. https://doi.org/10.1161/01.cir.103.5.691.
Soulat-Dufour L, Lang S, Addetia K, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Jean ML, Nhan P, Ben Said R, Kamami I, Issaurat P, Capderou E, Arnaud C, Boccara F, Lang RM, Cohen A. Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2022;79(10):951-61. https://doi.org/10.1016/j.jacc.2021.12.029.
Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Vanassche T, Potpara T, Camm AJ, Heidbüchel H; External reviewers. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021;23(10):1612-1676. https://doi.org/10.1093/europace/euab065. Erratum in: Europace. 2021 Jun 28.
Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-30. https://doi.org/10.7326/0003-4819-158-11-201306040-00007.
Thomas L, Abhayaratna WP. Left Atrial Reverse Remodeling: Mechanisms, Evaluation, and Clinical Significance. JACC Cardiovasc Imaging. 2017;10(1):65-77. https://doi.org/10.1016/j.jcmg.2016.11.003.
Tse HF, Lau CP. Does sinus rhythm beget sinus rhythm? Effects of prompt cardioversion on the frequency and persistence of recurrent atrial fibrillation. Card Electrophysiol Rev. 2003;7(4):359-65. https://doi.org/10.1023/B:CEPR.0000023139.45437.93.
Um KJ, McIntyre WF, Healey JS, Mendoza PA, Koziarz A, Amit G, Chu VA, Whitlock RP, Belley-Côté EP. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis. Europace. 2019;21(6):856-63. https://doi.org/10.1093/europace/euy310. Erratum in: Europace. 2019 Jun 1;21(6):863.
Umeojiako WI, Dali M, Lewis M, Chan T, Nageye F, Gladman J, Webb T, Patten T, Glessinger J, Hickford R, D’Souza S, Cecaro F, Martin W, Ghani S, Petzer E, Kabunga P. Electrical cardioversion for persistent atrial fibrillation in the era of catheter ablation: a real-world observational study. Eur J Arrhythm Electrophysiol. 2022;8(1):25-29. https://doi.org/10.17925/ejae.2022.8.1.25.
Van Gelder IC, Tuinenburg AE, Schoonderwoerd BS, Tieleman RG, Crijns HJ. Pharmacologic versus direct-current electrical cardioversion of atrial flutter and fibrillation. Am J Cardiol. 1999;84(9A):147R-151R. https://doi.org/10.1016/s0002-9149(99)00715-8.
Wałek P, Sielski J, Gorczyca I, Roskal-Wałek J, Starzyk K, Jaskulska-Niedziela E, Bartkowiak R, Wożakowska-Kapłon B. 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;15(1):e0228239. https://doi.org/10.1371/journal.pone.0228239.
Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92(7):1954-68. https://doi.org/10.1161/01.cir.92.7.1954.