Prediction of the recurrence of atrial fibrillation after cardioversion in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study

The early recurrence of atrial fibrillation (AF) after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. We evaluated patients in the AFFIRM study whose qualifying episode of AF lasted ≥48 hours and was terminated by car...

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Bibliographic Details
Published in:The American heart journal 2006-02, Vol.151 (2), p.390-396
Main Authors: Raitt, Merritt H., Volgman, Annabelle S., Zoble, Robert G., Charbonneau, Lyne, Padder, Farooq A., O'Hara, Gilles E., Kerr, David
Format: Article
Language:English
Subjects:
Aged
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Biological and medical sciences
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiology
Cardiology. Vascular system
Cardiovascular disease
Chi-Square Distribution
Coronary vessels
Diabetes
Echocardiography
Electric Countershock
Electrocardiography
Female
Heart
Humans
Hypertension
Logistic Models
Male
Medical sciences
Proportional Hazards Models
Recurrence
Risk Factors
Sinuses
Time Factors
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Summary:The early recurrence of atrial fibrillation (AF) after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. We evaluated patients in the AFFIRM study whose qualifying episode of AF lasted ≥48 hours and was terminated by cardioversion. Clinical, electrocardiographic, and echocardiographic risk factors associated with AF recurrence within 2 months of cardioversion and ≥2 cardioversions during the first year were identified using multivariate analysis in 1293 eligible patients. The risk factors for the recurrence of AF within 2 months of cardioversion were no coronary artery disease and an electrocardiographic lead II P-wave duration of >135 milliseconds. In the subset of patients not taking antiarrhythmic drug therapy, the multivariate risk factors were no coronary artery disease, second or greater episode of AF, left ventricular ejection fraction 2 cardioversions in the first year in patients taking antiarrhythmic medication were left atrial diameter >4.5 cm and mitral valve thickening. The overall sensitivity and specificity of these parameters for recurrence and repeated cardioversion are low. There are several risk factors for difficulty maintaining sinus rhythm after cardioversion of persistent AF. The clinical predictive value of these factors is low, and they probably should not be used to justify withholding rhythm control efforts in patients who might benefit from sinus rhythm.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2005.03.019