scholarly journals Echocardiographic E/e for the prediction of recurrent atrial fibrillation after ablation or electrical cardioversion: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Gomez ◽  
M K C Tan ◽  
D P Bailon ◽  
A L D Te-Rosano ◽  
R M Jimenez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Odds Ratio ◽  
Mean Difference ◽  
Electrical Cardioversion ◽  
Forest Plot ◽  
Weighted Mean ◽  
Dichotomous Data ◽  
Significant Difference ◽  
Af Recurrence

Abstract Background Atrial Fibrillation (AF) is the most common arrhythmia, with important sequelae if left untreated. Markers help to predict the recurrence of AF after an intervention like ablation or electrical cardioversion (ECV). E/e' ratio is an echocardiographic marker which is potentially useful in predicting AF recurrence, however, present data is conflicting. Adding a simple tool like E/e' ratio to evaluation of patients for AF intervention may help in advising patients better about their risk for recurrent AF after intervention without adding much cost to the diagnostic work-up. Purpose To determine if there is a significant difference in pooled mean E/e' ratio among AF patients with recurrence after ablation or ECV compared to those who maintained sinus rhythm, and to determine the odds ratio of recurrent AF given an abnormal E/e' ratio. Methods The investigators systematically searched Pubmed, Medline, Cochrane Database, and Google Scholar for articles on patients undergoing catheter ablation or ECV for AF and who were adjudicated on recurrence of the arrhythmia. We calculated the weighted mean difference of E/e' ratio between those with recurring AF and those who maintained sinus rhythm, and the odds ratio of AF recurrence given an abnormal E/e' ratio. Statistical analysis was done using RevMan 5.4.1 software. Results A total of 38 studies involving 7048 patients were included in the initial analysis (26 studies on ablation with continuous data and 2 with dichotomous data based on a set cutoff, and 10 studies on ECV). One study was excluded due to absence of a blanking period and and another due to outlaying data in funnel plot analysis. The remaining 36 studies with 6910 patients were analyzed. There was a significant difference in the weighted mean E/e' ratio between the two groups in AF patients undergoing ablation (Mean Difference (MD)=0.60 (95% CI [0.20,1.00] p=0.003, I2=63%]), and ECV (MD=2.07 (95% CI [1.66, 2.49] p<0.ehab724.0361, I2=12%), with an odds ratio of 1.88 (95% CI [1.04, 3.37] p=0.04, I2=52%) among those with dichotomous data. Subgroup analyses were done to reduce heterogeneity. E/e' ratio was not significantly different in the population of paroxysmal AF undergoing ablation (MD=0.64, 95% CI [−0.55, 1.83], p=0.29, I2=76%) but significantly different in patients with non-paroxysmal AF undergoing ECV (MD=2.19, 95% CI [1.82, 2.56], I2=0%). Conclusion This analysis suggests that a higher E/e' ratio may be used to predict recurrence of AF after ablation or ECV, especially in patients undergoing ECV. The heterogeneity of the data for E/e' ratio in AF ablation and the variety of co-morbid conditions to atrial fibrillation limits its clinical applicability. Further studies are recommended to determine the optimal cutoff of this ratio that would predict AF recurrence. FUNDunding Acknowledgement Type of funding sources: None. Forest plot for studies on Ablation Forest plot for studies on ECV

P178 Sinus rhythm restoration by catheter ablation improved cognitive function in elderly patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
K Fujiyoshi ◽  
M Minami ◽  
D Saito ◽  
T Hashimoto ◽  
T Yoshizawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cognitive Function ◽  
Catheter Ablation ◽  
Elderly Patients ◽  
Sinus Rhythm ◽  
Mmse Score ◽  
Effect Estimate ◽  
Significant Difference ◽  
The Impact ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) may cause cognitive impairment. However, the impact of sinus rhythm (SR) restoration by catheter ablation on the improvement of cognitive function remains to be elucidated. Methods A total of 57 consecutive elderly patients (70.8 ± 4.8 years old) who underwent catheter ablation for AF were prospectively enrolled. The change of cognitive function for 6 months was compared between patients with SR restoration (at least 3 months; n = 49) and patients with AF recurrence (n = 8). Cognitive function was evaluated by the mini-mental state examination (MMSE). Results There was no significant difference in baseline characteristics between the 2 groups, including MMSE score (27.3 ± 2.6 vs. 27.6 ± 1.5 points; p = 0.793). The change of MMSE score was significantly greater in patients with SR restoration than those with AF recurrence (0.28 ± 0.70 vs. − 0.50 ± 0.75 points; p = 0.006; Figure). The general liner modeling revealed that SR restoration (effect estimate, 0.369; 95% confidence interval, 0.110 to 0.627; p = 0.006) was independently associated with the change of MMSE score. Conclusion In elderly AF patients, successful restoration of SR by catheter ablation was associated with the improvement of cognitive function. Abstract P178 Figure

scholarly journals Electrical cardioversion to assess the association between self-reported symptoms and rhythm status in patients with persistent atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
ANL Hermans ◽  
NAHA Pluymaekers ◽  
TAR Lankveld ◽  
MJW Van Mourik ◽  
S Zeemering ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Symptom Burden ◽  
Optimal Strategies ◽  
Persistent Atrial Fibrillation ◽  
Electrical Cardioversion ◽  
Symptom Pattern ◽  
Asymptomatic Patients ◽  
Symptom Patterns

Abstract Funding Acknowledgements Type of funding sources: None. Background. Knowledge about the association between symptoms and rhythm status (symptom-rhythm correlation) has potential clinical implications as it may identify patients with atrial fibrillation (AF) who profit from rhythm control in regard to reduction in symptom burden and improvement in quality of life. However, standardized strategies to assess symptom-rhythm correlation in AF patients are currently not available. Purpose. This study aimed to assess symptom-rhythm correlation in patients with persistent AF using electrical cardioversion (ECV) as a diagnostic probe. Methods. We used ECV to examine symptom-rhythm correlation in 81 patients with persistent AF. The presence of self-reported symptoms before ECV and at the first outpatient AF clinic follow-up visit (within 1-month) was assessed to determine the prevalence of a symptom-rhythm correlation (defined as self-reported symptoms present during AF and absent in sinus rhythm or absent in AF and yet relief during sinus rhythm). The symptom-rhythm correlation was absent in patients with symptoms before ECV who remained symptomatic during sinus or in patients with symptoms prior to ECV and without symptoms in AF after ECV. Asymptomatic patients before ECV with or without symptoms in AF or sinus rhythm afterwards had no symptom-rhythm correlation as well. The symptom-rhythm correlation was unevaluable in patients who were symptomatic in AF before ECV and at the first outpatient AF clinic follow-up visit. In addition, predominant self-reported symptoms (symptoms with highest self-reported symptom burden) were assessed to evaluate the symptom patterns around ECV. Intra-individually variable symptom patterns were defined as changes in predominant self-reported symptoms within patients around ECV. Results. Symptom-rhythm correlation was assessed in all patients. Only in 18 patients (22%), a symptom-rhythm correlation could be documented. Twenty-eight patients (35%) did not show any symptom-rhythm correlation and 35 patients (43%) had an unevaluable symptom-rhythm correlation as these patients were in symptomatic AF both at baseline and at the first outpatient AF clinic follow-up visit. Importantly, self-reported symptom patterns around ECV were intra-individually variable in 10 patients (12%) without symptom-rhythm correlation (of which 9 patients (11%) had AF recurrence) and in 2 patients (2%) with an unevaluable symptom-rhythm correlation. Conclusions. In patients with persistent AF, the prevalence of a symptom-rhythm correlation around ECV is low, but ECV often changes symptom pattern. Further studies are warranted to identify more optimal strategies to assess symptom-rhythm correlation in patients with persistent AF. Abstract Figure. Symptom-rhythm correlation and patterns

scholarly journals Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials

2008 ◽  
Vol 23 (6) ◽  
pp. 520-530 ◽  
Author(s):  
Suzana Angélica Silva Lustosa ◽  
Humberto Saconato ◽  
Álvaro Nagib Atallah ◽  
Gaspar de Jesus Lopes Filho ◽  
Delcio Matos
Keyword(s):  
Hospital Mortality ◽  
Recurrent Disease ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Weighted Mean ◽  
D3 Lymphadenectomy ◽  
Statistical Heterogeneity ◽  
Significant Difference ◽  
Significant Statistical Heterogeneity

PURPOSE: To compare morbidity, mortality, recurrence and 5-year survival between D1 and D2 or D3 for treatment of gastric cancer. METHODS: Systematic review and meta-analysis of RCTs. Metaview in RevMan 4.2.8 for analysis; statistical heterogeneity by Cochran's Q test (P<0.1) and I² test (P>50%). Estimates of effect were calculated using random effects model. RESULTS: D2 or D3 was associated with higher in-hospital mortality, with RR = 2.13, p=0.0004, 95% CI, 1.40 to 3.25, I²=0%, P=0.63; overall morbidity showed higher incidence in D2 or D3, RR = 1.98, p<0.00001, 95% CI, 1.64 to 2.38, I² = 33.9%, P=0.20; operating time showed longer duration in D2 or D3, weighted mean difference of 1.05, p<0.00001, 95% CI, 0.71 to 1.38, I² = 78.7%, P=0.03, with significant statistical heterogeneity; reoperation showed higher rate in D2 or D3, with RR = 2.33, p<0.0001, 95% CI, 1.58 to 3.44, I² = 0%, P=0.99; hospital stay showed longer duration in the D2 or D3, with weighted mean difference of 4.72, p<0.00001, 95% CI, 3.80 to 5.65, I² = 89.9%, P<0.00001; recurrence was analyzed showed lower rate in D2 or D3, with RR = 0.89, p=0.02, 95% CI, 0.80 to 0.98, I² = 71.0%, P = 0.03, with significant statistical heterogeneity; mortality with recurrent disease showed higher incidence in D1, with RR = 0.88, p=0.04, 95% CI, 0.78 to 0.99, I² =51.8%, P=0.10; 5-year survival showed no significant difference, with RR = 1.05, p=0.40, 95% CI, 0.93 to 1.19, I² = 49.1% and P=0.12. CONCLUSIONS: D2 or D3 lymphadenectomy procedure is followed by higher overall morbidity and higher in-hospital mortality; D2 or D3 lymphadenectomy shows lower incidence of recurrence and lower mortality with recurrent disease, when analysed altogether with statistical heterogeneity; D2 or D3 lymphadenectomy has no significant impact on 5-year survival.

Transesophageal echocardiographic predictors for maintenance of sinus rhythm after electrical cardioversion off atrial fibrillation

1997 ◽  
Vol 79 (10) ◽  
pp. 1355-1359 ◽  
Author(s):  
Patrick M.J. Verhorst ◽  
Otto Kamp ◽  
Roelof C. Welling ◽  
Machiel J. Van Eenige ◽  
Cees A. Visser
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Electrical Cardioversion

scholarly journals Systolic blood pressure increases in patients with atrial fibrillation regaining sinus rhythm after electrical cardioversion

2019 ◽  
Vol 21 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Joakim Olbers ◽  
Ellen Jacobson ◽  
Fredrik Viberg ◽  
Nils Witt ◽  
Petter Ljungman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Sinus Rhythm ◽  
Systolic Blood Pressure ◽  
Electrical Cardioversion

scholarly journals 1014-214 The influence of duration of atrial fibrillation on maintenance of sinus rhythm by angiotensin II modulators after electrical cardioversion

2004 ◽  
Vol 43 (5) ◽  
pp. A106
Author(s):  
Yasuyuki Egami ◽  
Masami Nishino ◽  
Takahito Tamai ◽  
Tamaki Itakura ◽  
Shinichiro Suna ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Angiotensin Ii ◽  
Sinus Rhythm ◽  
Electrical Cardioversion

scholarly journals Atrial mechanical hypofunction after electrical cardioversion of persistent or long-lasting persistent atrial fibrillation: a retrospective cohort study

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Renato De Vecchis ◽  
Andrea Paccone ◽  
Marco Di Maio
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Sinus Rhythm ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Color Doppler ◽  
Roc Curves ◽  
Persistent Atrial Fibrillation ◽  
Electrical Cardioversion

In the present retrospective cohort study, we have evaluated the missed or delayed atrial mechanical recovery in a population of patients with persistent or long-lasting persistent AF who achieved restoration of sinus rhythm on the ECG by electrical cardioversion (ECV).  The endpoint of our   study was   the failure to recover the normal mechanics of the left atrium.  Inclusion criterion was the persistent or long-lasting persistent atrial fibrillation successfully treated by means of    ECV , provided that  a pertinent documentation  was made available, comprising ECG, conventional 2D echo-color-Doppler and   speckle tracking echocardiography(STE)  evaluation, with also a STE assessment  of the atria at the days 1, 30 and 90  from the ECV freely available within  the clinical record  of the patient. Out of a total of 80 patients with persistent or long-standing persistent AF, retrospectively enrolled, as many as  22.5% of them did not achieve the normalization of their  atrial STE profile, even though they had been converted to sinus rhythm on the ECG by means of ECV.  The building of ROC curves allowed us to establish that early measurements of global atrial strain could serve to predict  both the risk of failure to recover the atrial mechanical function and the one of AF relapses over a 12 month follow-up. The   values of 18% and 17% were also calculated  to serve as cut off values, respectively,  for the risk  of atrial mechanical dysfunction and for the risk of AF  relapses over a 12 month follow-up. Failure to recover the atrial reservoir function can accompany a restoration of sinus rhythm on the ECG in patients with long-standing persistent AF. In this case, a serial STE evaluation could be useful to evaluate the atrial hypofunction over time.

P1903Efficacy and safety of dronedarone after recent cardioversion in patients with atrial fibrillation/flutter: a post-hoc analysis of the EURIDIS/ADONIS trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Thind ◽  
H J Crijns ◽  
G V Naccarelli ◽  
J A Reiffel ◽  
V Corp Dit Genti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Heart Disease ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Hazard Ratio ◽  
Post Hoc ◽  
Rheumatic Heart ◽  
Af Recurrence

Abstract Background Cardioversion is commonly performed prior to antiarrhythmic drug initiation for atrial fibrillation/flutter (AF). There are limited data describing baseline differences in patients requiring cardioversion to maintain sinus rhythm compared to those who do not. Likewise, response to antiarrhythmic drugs, including dronedarone, specifically in patients requiring cardioversion has not been well defined. Purpose To evaluate efficacy and safety of dronedarone versus placebo in patients with non-permanent AF who had cardioversion within 5 days prior to randomization in EURIDIS/ADONIS. Methods To qualify for enrolment in EURIDIS/ADONIS patients were required to be in sinus rhythm for at least 1 hour preceding randomization. Of 1237 patients randomized (2:1 dronedarone to placebo), 364 needed cardioversion for study entry (dronedarone 243, placebo 121). AF recurrence was evaluated by ECG obtained during study visits, scheduled transtelephonic monitoring, or at symptom recurrence. Results Cardioversion patients were more likely to have rheumatic heart disease, valvular heart disease, any structural heart disease, and heart failure. Nonetheless, the median time to 1st AF recurrence was longer for dronedarone versus placebo both in cardioversion patients (50 versus 15 days, hazard ratio 0.76, 95% CI 0.59, 0.97) and no cardioversion patients (150 versus 77 days, hazard ratio 0.76, 95% CI 0.64, 0.90), as was time to 1st symptomatic recurrence (cardioversion: 347 versus 87 days, hazard ratio 0.65, 95% CI 0.49, 0.87; no cardioversion: 288 versus 120 days, hazard ratio 0.74, 95% CI 0.62, 0.90) (Figure 1). There was a trend towards fewer 1st AF hospitalizations within 12 months for dronedarone versus placebo (7.8 versus 12.4%, hazard ratio 0.60, 95% CI 0.31, 1.18 in cardioversion patients; 8.4 versus 10.4%, hazard ratio 0.74, 95% CI 0.47, 1.17 in no cardioversion patients). In cardioversion patients, rates of treatment-emergent adverse events with dronedarone versus placebo were 64 versus 66%, serious treatment-emergent adverse events were 19 versus 26%, permanent discontinuations were 9 versus 6%, and deaths were 0 versus 1%. Conclusions 1) Cardioversion-requiring patients have more baseline structural heart disease and overall shorter time to AF recurrence. 2) Dronedarone effectively delayed 1st AF recurrence versus placebo in patients with or without recent cardioversion. 3) Safety of dronedarone in cardioversion patients was similar to placebo and overall observations from EURIDIS/ADONIS despite baseline differences in comorbidities. Acknowledgement/Funding Sanofi, New York, New York, United States of America

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