Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation

doi:10.1016/0002-9149(89)90079-9

The American Journal of Cardiology

Volume 63, Issue 15, 1 May 1989, Pages 1065-1068

https://doi.org/10.1016/0002-9149(89)90079-9 Get rights and content

Abstract

Successful therapy of atrial fibrillation (AF) has been reportedly influenced by a variety of factors including patient age, type of Underlying heart disease, duration of arrhythmia, left ventricular function and left atrial (LA) size. To determine which of these factors are associated with maintenance of sinus rhythm after conversion, 43 patients with symptomatic chronic AF in the setting of a dilated left atrium (≥45 mm, range 45 to 78) were followed for at least 6 months after the return of sinus rhythm. Class IA drugs, IC drugs or amiodarone were used for therapy. Life table analysis showed sinus rhythm to be maintained in 81% for 6 months, 79% for 12 months and 60% for 24 months. Factors positively associated with success were conversion with drug therapy alone, duration of chronic AF ≤1 year, absence of mitral valve disease and LA dimension ≤60 mm (all p < 0.05). Patient age, left ventricular function and presence of coronary disease were not associated with outcome. Thus, patients with moderate LA dilatation (45 to 60 mm) and a short duration of chronic AF can often be maintained in sinus rhythm, especially if they convert with pharmacologic intervention alone.

References (30)

MY Flugelman et al.
Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosis
Am J Cardiol
(1984)
M Rossi et al.
The use of quinidine in cardioversion
Am J Cardiol
(1967)
A Borgeat et al.
Flecainide versus quinidine for conversion of atrial fibrillation to sinus rhythm
Am J Cardiol
(1986)
D David et al.
Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta adrenergic blocking agent
Am J Cardiol
(1979)
RL Gold et al.
Amiodarone for refractory atrial fibrillation
Am J Cardiol
(1986)
MA Brodsky et al.
Amiodarone for maintenance of sinus rhythm after conversion of atrial fibrillation in the setting of a dilated left atrium
Am J Cardiol
(1987)
WL Henry et al.
Relation between echocardiographically determined left atrial size and atrial fibrillation
Circulation
(1976)
G Ewy et al.
Response of atrial fibrillation to therapy: role of etiology and left atrial diameter
J Electrocardiol
(1980)
J Parkinson et al.
Quinidine treatment of auricular fibrillation
Q J Med
(1928–1929)
G Miller et al.
The effect of procainamide (Pronestyl) in clinical auricular fibrillation and flutter
Circulation
(1952)

JJ Morris et al.

Electrical conversion of atrial fibrillation

Ann Intern Med

(1966)

JI Hall et al.

Factors affecting cardioversion of atrial arrhythmias with special reference to quinidine

Br Heart J

(1968)

E Byrne-Quinn et al.

Maintenance of sinus rhythm after DC reversion of atrial fibrillation: a double blind controlled trial of long-acting quinidine bisulphate

Br Heart J

(1970)

P Szekely et al.

Maintenance of sinus rhythm after atrial defibrillation

Br Heart J

(1970)

E Waris et al.

Factors influencing persistence of sinus rhythm after DC shock treatment of atrial fibrillation

Acta Med Scand

(1971)

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A correlation between the LA size and the incidence and complexity of atrial arrhythmias exists in an asymptomatic elderly population.22 Large atria are associated with a lower success rate of pharmacological and electrical cardioversion as well as ablation therapy in patients with AF.15–17 Similarly, a high LA pressure, a high LA wall stress, and a high plasma level of natriuretic peptides (secreted after stretch) each predict AF recurrence after ablation therapy.12–14
Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with increased mortality. Heart failure, hypertension, valvular disease, and obstructive sleep apnea are risk factors for incident AF. A common characteristic of these diseases is that they increase atrial wall stretch. Multiple experimental studies confirm a proarrhythmic effect of atrial stretch. Conversely, a reduction in stretch is antiarrhythmic. A therapeutic target for AF, therefore, lies in local reduction of atrial stretch. This review focuses on atrial stretch and its clinical associations in patients with AF and its downstream effects on electrophysiology. We discuss the possible application of targeted atrial stretch reduction in AF prevention. We conclude that a reduction in local atrial stretch should be considered an essential element in rhythm control.
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Therefore, we believe that the AFV-tvi measured in the right atrium has the highest intrinsic predictive power regarding immediate success of ECV. The most consistent clinical predictors of successful ECV were a short duration of the AF episode, younger age, a small atrial size, and the use of antiarrhythmic drugs or β-blockers.16–20 There is increasing evidence that AF is associated with inflammation, which might be reduced by statins.21
Electrophysiological studies demonstrate that a short atrial fibrillation cycle length (AFCL) is related with poor outcome of electrical cardioversion (ECV) of atrial fibrillation (AF). We found previously that the mechanical AFCL (AFCL-tvi) and atrial fibrillatory velocity (AFV-tvi) may be determined noninvasively using color tissue velocity imaging (TVI) and closely relates to the electrophysiological AFCL.
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We prospectively studied 133 patients with persistent AF by performing echocardiography before ECV and measured the AFCL-tvi and AFV-tvi in the right atrium and left atrium. Recurrent AF was monitored.
Nineteen (14%) patients had failure of ECV, 42 (32%) remained in sinus rhythm after 1-year follow-up, and 72 (54%) had a recurrence of persistent AF. Patients with immediate ECV failure had a lower median AFV-tvi measured in the right atrium than did patients with a successful ECV: 0.7 cm/s (0.2–1.0 cm/s) vs 1.7 cm/s (0.9–2.8 cm/s) (P = .008). Patients with maintenance of sinus rhythm after 1 year had a longer AFCL-tvi measured in the left atrium than did patients with recurrence of AF (150 ms vs 137 ms; P = .017) and had a higher AFV-tvi in both atria (1.4 vs 0.9 cm/s in the left atrium; P = .013 and 2.2 vs 1.4 cm/s in the right atrium; P = .011). Multivariate analyses showed that all atrial TVI parameters were independently associated with the maintenance of sinus rhythm after 1 year.
Higher atrial fibrillatory wall velocities and longer AFCLs determined by echocardiography are associated with acute and long-term success of ECV.
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Traditionally the provision of elective external direct current cardioversion (EDCCV) for patients with atrial arrhythmias has been doctor-led. Increasing demands on hospital beds and time pressures for doctors has driven the desire for an alternative approach. We established a nurse-led cardioversion service in 2006 and present our experience.
A prospective database of patients undergoing elective EDCCV between July 2006 and July 2013 was collected. Demographic data, arrhythmia, success and immediate complications of cardioversion were recorded.
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Nurse-led elective EDCCV is a safe and effective way of restoring sinus rhythm in patients with AF or atrial flutter, with additional benefits to resource provision.
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The LA can act to increase LA pressure (in significant atrial disease) and can react to increased LV filling pressure (in significant ventricular disease). There is a growing body of evidence demonstrating that LA enlargement is a marker of significant atrial22 or ventricular disease.23,24 In patients with HCM, the enlargement of the LA has proved to be inconsistently related to LV diastolic dysfunction, mitral regurgitation degree, or LV dynamic outflow tract obstruction.25
Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. We aimed to assess left atrial (LA) function by two-dimensional speckle tracking echocardiography and its relation with left ventricular (LV) function and clinical status in patients with HCM.
We prospectively enrolled 37 consecutive patients with HCM and 37 normal subjects with similar age and gender distribution. Longitudinal LV strain (ε) and LA ε and strain rate (Sr) parameters (systolic, early diastolic, and late diastolic during atrial contraction) were assessed.
Peak LAε and LA Sr parameters were significantly lower in patients compared with controls (P ≤ .001 for all). In patients, all LA function parameters correlated with LVε (P < .003 for all). Indexed LA volume, LA function parameters, and mitral regurgitation degree were the main correlates of New York Heart Association class; late diastolic strain rate during atrial contraction was the only independent predictor of symptomatic status.
In patients with HCM, LA function is significantly reduced and related to LV dysfunction. Moreover, LA booster pump function emerged as an independent correlate of heart failure symptoms in this setting.
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Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation

Abstract

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Relation between echocardiographically determined left atrial size and atrial fibrillation

Circulation

Response of atrial fibrillation to therapy: role of etiology and left atrial diameter

J Electrocardiol

Quinidine treatment of auricular fibrillation

Q J Med

The effect of procainamide (Pronestyl) in clinical auricular fibrillation and flutter

Circulation

Electrical conversion of atrial fibrillation

Ann Intern Med

Factors affecting cardioversion of atrial arrhythmias with special reference to quinidine

Br Heart J

Maintenance of sinus rhythm after DC reversion of atrial fibrillation: a double blind controlled trial of long-acting quinidine bisulphate

Br Heart J

Maintenance of sinus rhythm after atrial defibrillation

Br Heart J

Factors influencing persistence of sinus rhythm after DC shock treatment of atrial fibrillation

Acta Med Scand