Predictors of sinus rhythm maintenance in patients with late persistent atrial fibrillation at 6-months follow-up after direct current cardioversion

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Published: Sep 18, 2023
DOI: https://doi.org/10.31928/2664-4479-2023.3-4.719
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“Predictors of Sinus Rhythm Maintenance in Patients With Late Persistent Atrial Fibrillation at 6-Months Follow-up After Direct Current Cardioversion”. Ukrainian Journal of Cardiology, vol. 30, no. 3-4, Sept. 2023, pp. 7-19, https://doi.org/10.31928/2664-4479-2023.3-4.719.
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Vol. 30 No. 3-4 (2023): Ukrainian Journal of Cardiology
Section
Cardiac arrhythmias
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This work is licensed under a Creative Commons Attribution 4.0 International License.

Main Article Content

Ya. V. Skybchyk
Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine Heart Institute, Ministry of Health of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0002-4443-3137
O. J. Zharinov
Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0002-4089-9757

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:

персистентна фібриляція передсердь, тривалі епізоди, електрична кардіоверсія, контроль ритму, міокард, серцева недостатність

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