Atrial fibrillation recurrence and spontaneous conversion to sinus rhythm after cardiac surgery: Insights from 426 patients with continuous rhythm monitoring

2021 ◽  
Author(s):  
Efstratios I. Charitos ◽  
Florian E. M. Herrmann ◽  
Paul D. Ziegler
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Atrial Fibrillation Recurrence ◽  
Rhythm Monitoring ◽  
Spontaneous Conversion

scholarly journals Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis†

2017 ◽  
Vol 26 (3) ◽  
pp. 504-511 ◽  
Author(s):  
Nicole Lowres ◽  
Georgina Mulcahy ◽  
Kai Jin ◽  
Robyn Gallagher ◽  
Lis Neubeck ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Postoperative Atrial Fibrillation ◽  
Atrial Fibrillation Recurrence

Surgical Ablation for Atrial Fibrillation in Cardiac Surgery a Meta-Analysis and Systematic Review

2010 ◽  
Vol 5 (2) ◽  
pp. 84-96 ◽  
Author(s):  
Davy C. H. Cheng ◽  
Niv Ad ◽  
Janet Martin ◽  
Eva E. Berglin ◽  
Byung-Chul Chang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Resource Utilization ◽  
Meta Analysis ◽  
Surgical Ablation ◽  
Af Ablation ◽  
All Cause Mortality ◽  
Meta Regression

Objectives This meta-analysis sought to determine whether surgical ablation improves clinical outcomes and resource utilization compared with no ablation in adult patients with persistent and permanent atrial fibrillation (AF) undergoing cardiac surgery. Methods A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials of surgical ablation versus no ablation in patients with AF undergoing cardiac surgery up to April 2009. The primary outcome was sinus rhythm. Secondary outcomes included survival and any other reported clinically relevant outcome or indicator of resource utilization. Odds ratios (OR) and weighted mean differences (WMD) and their 95% confidence intervals (95% CI) were analyzed as appropriate using the random effects model. Heterogeneity was measured using the I2 statistic. Meta-regression was performed to explore the relationship between the benefit from surgical AF and duration of follow-up. Results Thirty-three studies met the inclusion criteria (10 RCTs and 23 non-RCTs) for a total of 4647 patients. The number of patients in sinus rhythm was significantly improved at discharge in the surgical AF ablation group versus (68.6%) the surgery alone group (23.0%) in RCTs (OR 10.1, 95% CI 4.5–22.5) and non-RCTs (OR 7.15, 95% CI 3.42–14.95). This effect on sinus rhythm (74.6% vs. 18.4%) remained at follow-up of 1 to 5 years (OR 6.7, 95% CI 2.8–15.7 for RCT, and OR 15.5, 95% CI 6.6–36.7 for non-RCT). The risk of all-cause mortality at 30 days was not different between the groups in RCT (OR 1.20, 95% CI 0.52–3.16) or non-RCT studies (OR 0.99, 95% CI 0.52–1.87). In studies reporting all-cause mortality at 1 year or more (up to 5 years), mortality did not differ in RCT studies (OR 1.21, 95% CI 0.59–2.51) but was significantly reduced in non-RCT studies (OR 0.54, 95% CI 0.31–0.96). Stroke incidence was not reduced significantly; however, in meta-regression, the risk of stroke decreased significantly with longer follow-up. Other clinical outcomes were similar between groups. Operation time was significantly increased with surgical AF ablation; however, overall impact on length of stay was variable. Conclusions In patients with persistent or permanent AF who present for cardiac surgery, the addition of surgical AF ablation led to a significantly higher rate of sinus rhythm in RCT and non-RCT studies compared with cardiac surgery alone, and this effect remains robust over the longer term (1–5 years). Although non-RCT studies suggest the possibility of reduced risk of stroke and death, this remains to be proven in prospective RCTs with adequate power and follow-up.

scholarly journals Restoring sinus rhythm in patients with previous pacemaker implantation submitted to cardiac surgery and concomitant surgical ablation of atrial fibrillation☆

2008 ◽  
Vol 33 (4) ◽  
pp. 596-599
Author(s):  
Marta P. Marques ◽  
João Q. Melo ◽  
Michel Knaut ◽  
Ottavio Alfieri ◽  
Stefano Benussi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Pacemaker Implantation ◽  
Surgical Ablation

scholarly journals A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence

Circulation ◽  
2012 ◽  
Vol 126 (7) ◽  
pp. 806-814 ◽  
Author(s):  
Efstratios I. Charitos ◽  
Ulrich Stierle ◽  
Paul D. Ziegler ◽  
Malte Baldewig ◽  
Derek R. Robinson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Comprehensive Evaluation ◽  
Atrial Fibrillation Recurrence ◽  
Monitoring Strategies ◽  
Rhythm Monitoring

scholarly journals “Stunning” of the left atrium after spontaneous conversion of atrial fibrillation to sinus rhythm

1998 ◽  
Vol 32 (7) ◽  
pp. 2081-2086 ◽  
Author(s):  
Eric K Louie ◽  
Dong Liu ◽  
Sandra I Reynertson ◽  
Henry S Loeb ◽  
Thomas L McKiernan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Spontaneous Conversion

scholarly journals Timing of cardioversion in atrial fibrillation: the sooner the better?

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L41-L43
Author(s):  
Piera Capranzano ◽  
Valeria Calvi
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Limited Resources ◽  
Psychological Burden ◽  
Treatment Pathway ◽  
Recent Onset ◽  
Wait And See ◽  
Costs Of Treatment ◽  
Spontaneous Conversion

Abstract Management of recent-onset (<36 h) atrial fibrillation (AF) in the emergency room is highly variable, particularly concerning the type and timing of cardioversion, and the logistics of the treatment pathway. In clinical practice, it is fairly common for patients with recent-onset AF an attempt at re-establishing sinus rhythm, either with electric or pharmacologic cardioversion, as soon as feasible. Nonetheless, a ‘wait-and-see’ approach, and potentially delayed cardioversion, could represent a valid alternative to early cardioversion, considering that, often, in recent-onset AF, sinus rhythm is re-established spontaneously, thus repealing the need for active cardioversion, hence avoiding the possible risks of treatment. These concepts form the rationale for a recent multicentric randomized trial, Rate Control vs. Electrical Cardioversion Trial 7 – Acute Cardioversion vs. Wait and See (RACE 7 ACWAS), comparing the efficacy of delayed cardioversion, within 48 h from symptoms onset, in case of lack of spontaneous conversion, with early cardioversion in symptomatic patients with recent-onset AF. In patients presenting to the emergency department with recent-onset, symptomatic AF, a wait-and-see approach was non-inferior to early cardioversion in maintaining the sinus rhythm at 4 weeks. Nonetheless a system employing a delayed cardioversion strategy increases the costs of treatment, complicates the treatment pathway, and could represent a psychological burden for the patients. Accordingly, delayed cardioversion could not represent a practical choice for many hospitals with limited resources and without an adequate outpatient organization.

Abstract 13747: Investigation of the Probability of Spontaneous Conversion From Atrial Fibrillation to Sinus Rhythm Utilizing Continuous Rhythm Monitoring

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Paul D Ziegler ◽  
Efstratios I Charitos
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Time Course ◽  
Hierarchical Regression ◽  
Related Factors ◽  
Blue Line ◽  
Spontaneous Conversion ◽  
Af Recurrence ◽  
Red Line

Introduction: Atrial fibrillation (AF) recurrence or spontaneous conversion to sinus rhythm (SR) are regarded as random events. Hypothesis: We hypothesized that the probability of spontaneous conversion to SR decreases as more time is spent in AF. We attempt to quantify this phenomenon and investigate factors that can affect this probability. Methods: Cardiac rhythm histories of 1195 patients (age 73.0 ± 10.1, follow-up: 349 ± 40 days; 14533 AF episodes) with implantable devices were reconstructed and analyzed. No patients received cardioversion, AF ablation, or any obvious AF therapies during follow-up. Patients with no AF recurrence or continuous AF during follow up were excluded. Hierarchical regression methods were employed to investigate the time course of the probability of rhythm change and factors that influence it. Results: Probabilities of spontaneous conversion from AF to SR (solid blue line) and recurrence of AF in patients with SR (solid red line) are shown in the Figure. For patients in AF , spontaneous conversion probability significantly decreases with time spent in AF and plateaus after ~7 days (dotted blue line). Similarly for patients in SR, increasing time in SR reduces the probability of developing AF (solid red line) and plateaus after ~7 days (dotted red line). Patient age (p<0.001), LVEF (p<0.05) and presence of coronary artery disease (p<0.01) significantly influence the spontaneous conversion probabilities independent from AF burden. Conclusions: Spontaneous SR conversion or AF recurrence diminishes with increasing time spent in AF or SR, respectively, and are influenced by several patient-related factors. These findings suggest that patients should be closely monitored after AF recurrence or SR conversion.

scholarly journals Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling

2015 ◽  
Vol 4 (2) ◽  
pp. 129-137 ◽  
Author(s):  
Johannes W. Dietrich ◽  
Patrick Müller ◽  
Fabian Schiedat ◽  
Markus Schlömicher ◽  
Justus Strauch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Fas Ligand ◽  
Volume Index ◽  
Atrial Remodeling ◽  
Conduction Time ◽  
Reference Ranges ◽  
Nonthyroidal Illness ◽  
Low T3

Background: Although hyperthyroidism predisposes to atrial fibrillation, previous trials have suggested decreased triiodothyronine (T3) concentrations to be associated with postoperative atrial fibrillation (POAF). Therapy with thyroid hormones (TH), however, did not reduce the risk of POAF. This study reevaluates the relation between thyroid hormone status, atrial electromechanical function and POAF. Methods: Thirty-nine patients with sinus rhythm and no history of atrial fibrillation or thyroid disease undergoing cardiac surgery were prospectively enrolled. Serum concentrations of thyrotropin, free (F) and total (T) thyroxine (T4) and T3, reverse (r)T3, 3-iodothyronamine (3-T1AM) and 3,5-diiodothyronine (3,5-T2) were measured preoperatively, complemented by evaluation of echocardiographic and electrophysiological parameters of cardiac function. Holter-ECG and telemetry were used to screen for POAF for 10 days following cardiac surgery. Results: Seven of 17 patients who developed POAF demonstrated nonthyroidal illness syndrome (NTIS; defined as low T3 and/or low T4 syndrome), compared to 2 of 22 (p < 0.05) patients who maintained sinus rhythm. In patients with POAF, serum FT3 concentrations were significantly decreased, but still within their reference ranges. 3,5-T2 concentrations directly correlated with rT3 concentrations and inversely correlated with FT3 concentrations. Furthermore, 3,5-T2 concentrations were significantly elevated in patients with NTIS and in subjects who eventually developed POAF. In multivariable logistic regression FT3, 3,5-T2, total atrial conduction time, left atrial volume index and Fas ligand were independent predictors of POAF. Conclusion: This study confirms reduced FT3 concentrations in patients with POAF and is the first to report on elevated 3,5-T2 concentrations in cardiac NTIS. The pathogenesis of NTIS therefore seems to involve more differentiated allostatic mechanisms.

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