Predictors of arrhythmia recurrence after the first episode of atrial fibrillation during 6-months follow-up
Article Sidebar
Main Article Content
Abstract
The aim – to determine the clinical, anamnestic characteristics and indicators of the structural and functional state of the myocardium, which may predict arrhythmia recurrence in patients with reverse episode of the first-diagnosed atrial fibrillation (AF) during 6-months follow-up.
Material and methods. Among 124 patients with first diagnosed AF in 88 patients AF episode terminated with sinus rhythm restoration. In order to compare the baseline clinical, anamnestic and instrumental characteristics, groups of patients with (n=44) and without (n=44) documented recurrence of AF were formed retrospectively. In these groups, the frequency of detection of risk factors, concomitant diseases, laboratory parameters, the course of the first episode of AF, data on echocardiography, and daily ECG monitoring after recovery of sinus rhythm were compared. Multifactor analysis was performed to determine the independent predictors of AF relapse.
Results.The relapsing course of AF is associated with older age, higher incidence of certain concomitant diseases, in particular, heart failure, hypertension and diabetes, and more severe left ventricular hypertrophy. The most significant predictors of the occurrence of arrhythmia recurrence after the first episode of AF after the restoration of sinus rhythm were CHA2DS2-VASc score (≥ 2 versus 0: odds ratio (OR) 3.135 (95 % confidence intervals (CI) 1.341–7.333); Р=0.008) and C-reactive protein level (≥ 6 mg/L versus < 6 mg/L: OR 3.041 (95 % CI 1.656–5.584) P<0.001).
Conclusions. During 6-months follow-up arrhythmia recurrence was registered in 50 % patients with first episode of AF. Independent predictors of the AF recurrence were CHA2DS2-VASc score two or more, as well as the CRP ≥ 6 mg/L. These aspects should be taken into account at individualized assessment of the need for antiarrhythmic and antithrombotic therapy in patients with first detected AF after restoration of sinus rhythm.
Article Details
Keywords:
References
Гржибовский А. М. Анализ номинальных данных (независимые наблюдения) // Экология человека.– 2008.– № 6.– C. 58–68.
Целуйко В.И., Лозовая Т.А. Особенности цитокинового профиля у больных с пароксизмами фибрилляции предсердий при ишемической болезни сердца и сердечной недостаточности // Укр. кардіол. журн.– 2007.– № 4.– С. 18–23.
ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography // J. Amer. Soc. Echocardiogr.– 2007.– Vol. 20.– P. 787–805.
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.– Vol. 114.– P. 257–354.
Barrett T.W., Self W.H., Wasserman B.S. et al. Evaluating the HATCH score for predicting progression to sustained atrial fibrillation in ED patients with new atrial fibrillation // Am. J. Emerg. Med.– 2013.– Vol. 31 (5).– P. 792–797.
De Vos C.B., Pisters R., Nieuwlaat R. et al. Progression from paroxysmal to persistent atrial fibrillation: clinical correlates and prognosis // J. Am. Coll. Cardiol.– 2010.– Vol. 55.– P. 725–731.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC // Eur. Heart J.– 2012.– Vol. 33.– P. 1787–1847.
Gürdoğan M., Ari H., Tenekecioğlu E. et al. Predictors of Atrial Fibrillation Recurrence in Hyperthyroid and Euthyroid Patients // Arq. Bras. Cardiol.– 2016.– Vol. 106 (2).– P. 84–91.
Humphries K.H., Kerr C.R., Connolly S.J., et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome // Circulation.– 2001.– Vol. 103 (19).– P. 2365–2370.
Kerr C.R., Humphries K.H., Talajic M. et al. Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: results from the Canadian Registry of Atrial Fibrillation // Am. Heart J.– 2005.– Vol. 149.– Р. 489–496.
Kirchhof P., Benussi S., Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS // Eur. Heart. J.– 2016.– Vol. 37 (38).– P. 2893–2962.
Kornej J., Hindricks G., Kosiuk J. et al. Comparison of CHADS2, R2CHADS2, and CHA2DS2-VASc scores for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation: the Leipzig Heart Center AF Ablation Registry // Circ. Arrhythm. Electrophysiol.– 2014.– Vol. 7 (2).– P. 281–287.
Lang R., Badano Luigi P., Mor-Avi V. et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging // J. Am. Soc. Echocardiogr.– 2015.– Vol. 28.– P. 1440–1457.
Levey A.S., Stevens L.A., Schmid C.H. et al. A new equation to estimate glomerular filtration rate // Ann. Intern. Med.– 2009.– Vol. 150.– P. 604–612.
Nyrnes A., Njølstad I., Mathiesen E.B. et al. Inflammatory biomarkers as risk factors for future atrial fibrillation. An eleven-year follow-up of 6315 men and women: the Tromsø study // Gend. Med.– 2012.– Vol. 9 (6).– P. 536–547.
Ponikowski P., Voors A.A., Anker S.D. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) // Еur. Heart J.– 2016.– Vol. 37.– P. 2129–2220.
Sata N., Hamada N., Horinouchi T. et al. C-Reactive protein and atrial fibrillation. Is inflamation a consequence or a cause of atrial fibrillation? // Jpn. Heart J.– 2004.– Vol. 45.– P. 441–445.
The Task Force for the management of atrial fibrillation of the European Society of Cardiology. Guidelines for the management of atrial fibrillation // Eur. Heart. J.– 2010.– Vol. 31.– P. 2369–2429.
Yo C.H., Lee S.H., Chang S.S. et al. Value of high-sensitivity C-reactive protein assays in predicting atrial fibrillation recurrence: a systematic review and meta-analysis // Brit. Med. J. Open.– 2014.– Vol. 4 (2).