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Clin. Cardiol. 24, 238–244 (2001)
Mats Frick, M.D., Viveka Frykman, M.D.,* Mats Jensen-Urstad, M.D., Ph.D.,* Jan Östergren, M.D., Ph.D.,† Mårten Rosenqvist, M.D., Ph.D.*
Department of Cardiology, South Hospital; Departments of *Cardiology and †Medicine, Karolinska Hospital, Stockholm, Sweden
Summary
Background: The recurrence rate of atrial fibrillation (AF) after elective cardioversion is high.
Hypothesis: The study aimed to identify clinical predictors for successful electrical cardioversion and maintenance of sinus rhythm after a first electrical cardioversion in patients with persistent AF without concomitant antiarrhythmic drugs of class I and III.
Methods: Consecutive outpatients (n = 166) with persistent AF for >1 month, scheduled for elective cardioversion, were prospectively included in the study. A clinical investigation, echocardiographic assay, and Holter electrocardiogram (ECG) before and ECG 4 weeks after cardioversion, were performed in all patients.
Results: The mean age of the patients was 68 years (range 45–83) and duration of AF was 5 (1–48) months. Sinus rhythm was established in 124 (75%) patients. In multivariate analysis, only duration of AF <6 months (p<0.04, odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1 to 4.7) and patients weight (p<0.03, OR 2.3, 95% CI 1.1 to 4.8 for weight <80 kg) were identified as independent predictors of successful cardioversion. At 4 weeks after cardioversion, only 46 (37%) of 124 patients maintained sinus rhythm. Independent factors for maintenance of sinus rhythm, in multivariate analysis, were AF <3 months (p<0.04, OR 2.5, 95% CI 1.1 to 5.6), treatment with beta blockers (p<0.00001, OR 7.0, 95% CI 3.0 to 16.3) or verapamil/diltiazem (p<0.04, OR 3.6, 95% CI 1.1 to 12.1), and right atrial dimension <37 mm (p<0.02, OR 5.9, 95% CI 1.4 to 25.4).
Conclusions: In patients with persistent AF, the patient's weight and the duration of AF are independent predictors for a successful cardioversion. Short duration of AF, treatment with beta blockers or verapamil/diltiazem, and right atrial area/dimension are independent predictors for maintenance of sinus rhythm.
Key words: atrial fibrillation, cardioversion, arrhythmias
This study was supported by the Swedish Heart and Lung Foundation.
Address for reprints:
Mats Frick, M.D.
Department of Cardiology
South Hospital
S-118 83 Stockholm, Sweden
Received: February 15, 2000
Accepted with revision: May 23, 2000