<p>Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population</p>

Abstract Electrical cardioversion is one of the recognized methods of treatment of atrial fibrillation (AF)/maintenance of sinus rhythm. There are no factors that allow to predict the response to electrical cardioversion in the elderly population. Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults – we hypothesized that frailty can be a factor to predict the effectiveness electrical cardioversion. Methods 199 consecutive patients over 60 years (average age 71.41±6.99; 40.2% W) with AF hospitalized due to electrical cardioversion. The follow-up period for maintenance of sinus rhythm was 180±14 days. The Tilburg Frailty Indicator was used to examine the frailty before cardioversion. A global score of 5 points or more let us to respond the frailty syndrome. Results 174 patients out of 199 (87.4%) were found to have electrical cardioversion be effective. Frailty was recognized in 68 out of the 199 (34.17%). There was 66.2% (45/68) effectiveness in the frailty-affected group, whereas there was 99.2% (130/131) in the robust group; p=0.ehz748.0653. 87.9% patients have maintenance sinus rhythm after 6 months; in the frailty affected group it was 75% vs 94.6% in robust group; p=0.ehz748.0653. In the logistic regression, frailty (OR: 0.41, 95% CI: 0.2870–0.0,5851; p<0.0001) was emerged as an independent predictor of effectiveness of electrical cardioversion. The ROC curves for frailty in the effectiveness electrical cardioversion are presented in the figure below – left panel. The area under the curve is 0.856 (95% CI - 0.799–0.902). The cutoff value for a frailty recognition was 4 (p<0.0001). Similarly, in the logistic regression, frailty (OR: 0.65, 95% CI: 0.5010–0.8330; p=0.0003) was also emerged as an independent predictor of maintenance sinus rhythm. The ROC curves for frailty in the maintenance of sinus rhythm are presented in the figure – right panel. The area under the curve is 0.718 (95% CI - 0.650–0.779). The cutoff value for a frailty recognition in this case was also 4 (p<0.0001). ROC curves Conclusion Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4, improve the prediction of effectiveness of electrical cardioversion as well as maintenance of sinus rhythm.

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Rhythm-control vs rate-control in the elderly: When to do it and which drug to prefer?

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2018.949 ◽

2018 ◽

Vol 88 (2) ◽

Author(s):

Giovanni Luca Botto ◽

Carlo Piemontese ◽

Giovanni Russo

Keyword(s):

Atrial Fibrillation ◽

Elderly Patient ◽

Rate Control ◽

Ischemic Cardiomyopathy ◽

Elderly Population ◽

Antiarrhythmic Drugs ◽

Treatment Options ◽

The Elderly ◽

Rhythm Control ◽

Abnormal Rate

Atrial fibrillation (AF) is a relevant cardiovascular condition that is more prevalent in the elderly patients aged over 65 years. AF, with abnormal rate and rhythm can cause symptoms directly or indirectly by exacerbating other frequently coexisting cardiac conditions such as valvular heart disease, hypertension, ischemic cardiomyopathy, dilated cardiomyopathy, and hypertrophic cardiomyopathy. Evidence suggests that aging-related cardiovascular changes predispose to the elderly to AF. Current therapeutic options such as antiarrhythmic drugs have not been extensively evaluated in the elderly population. Emerging pharmacological and non-pharmacological treatment options for the management of AF, such as dronedarone or catheter ablation, are of particular interest in the elderly. The present paper reviews the pathophysiology, diagnosis, and the management of AF in the elderly patient.

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

EP Europace ◽

10.1093/europace/euab116.113 ◽

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

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

The American Journal of Cardiology ◽

10.1016/s0002-9149(97)00139-2 ◽

1997 ◽

Vol 79 (10) ◽

pp. 1355-1359 ◽

Cited By ~ 47

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

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

Journal of Clinical Hypertension ◽

10.1111/jch.13496 ◽

2019 ◽

Vol 21 (3) ◽

pp. 363-368 ◽

Cited By ~ 3

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

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

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(04)90442-1 ◽

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

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A new method to assess sinus rhythm maintenance likelihood before electrical cardioversion of persistent atrial fibrillation

2007 Computers in Cardiology ◽

10.1109/cic.2007.4745462 ◽

2007 ◽

Author(s):

R. Alcaraz ◽

J.J. Rieta

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Persistent Atrial Fibrillation ◽

Electrical Cardioversion ◽

New Method ◽

Sinus Rhythm Maintenance

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

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2019.1178 ◽

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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