Antiarrhythmic Agents in Facilitating Electrical Cardioversion of Atrial Fibrillation and Promoting Maintenance of Sinus Rhythm

Cardiology ◽  
2001 ◽  
Vol 95 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Gregory M. Marcus ◽  
Ruey J. Sung
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Electrical Cardioversion ◽  
Antiarrhythmic Agents

Abstract 2441: A Controlled Randomized Trial of Biatrial Ablation for Curing Long-lasting Permanent Atrial Fibrillation (The Decomplex Trial)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Giuseppe Augello ◽  
Vincenzo Santinelli ◽  
Amarild Cuko ◽  
Filippo Gugliotta ◽  
Gabriele Vicedomini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Test Group ◽  
Left Ventricular ◽  
Electrical Cardioversion ◽  
Control Group ◽  
Radiofrequency Energy ◽  
Antiarrhythmic Agents ◽  
Permanent Atrial Fibrillation ◽  
Repeat Procedure

Background: patients with long-lasting permanent atrial fibrillation (AF) are often destined to remain in AF life-long. In this cohort outcomes of ablation techniques are disappointing, with 20 –74% success rate and 30 –50% repeat procedure. The adjunctive clinical benefit of targeting multiple right and left atrial (LA) sites beyond the pulmonary vein (PV)-LA junction with the aim of achieving acute AF termination has not been prospectively evaluated in a randomized study. Methods and results: 60 patients with permanent atrial fibrillation of more than 1 year duration, with early recurrence after electrical cardioversion and medical therapy with one or more antiarrhythmic agents were enrolled (mean age 59±10, mean AF duration 60 months, mean LA dimension 44±7 mm, left ventricular EF >40% in all) and randomized to standard circumferential PV ablation (CPVA, control group, N=30) or an extended CPVA schema targeting also inferior LA, atrial septum, LA appendage, coronary sinus and right atrium (test group, N=30). In the test group the procedural endpoint was sinus rhythm (SR) restoration by radiofrequency energy; at each step average cycle length was measured and ablation was stopped if patient gained SR. In the control group the standard CPVA technique was applied. All patient transmitted daily transtelephonic ECG strips whereas at 3, 6 and 12 months an echocardiogram and a 48 hour Holter was obtained. Antiarrhythmic drug therapy was continued for 3 months after ablation in both group (blanking period in which patients were allowed to undergo electrical cardioversion). AF terminated in 5% and 55% of control and test subjects; mean procedure duration was 66 and 88 minutes in the 2 groups; No significant complications occurred in both groups. After a mean follow-up of 4 months, 67% of control patients were sinus as compared with 83% in the test group (p<0.05). 2 and 2 patient undergoing a repeat procedure for recurrent AF for AF (N=2) and AT (N=2). Acute AF termination was the strongest endpoint of SR maitainance (p<0.01) Conclusion: Preliminary data show that a modified CPVA ablation strategy in patients with permanent AF is associated with acute AF termination in 55% of patients and achieves medium term restoration and maintenance of sinus rhythm in 83% of patients.

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

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.

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