Left atrial emptying fraction identified as a prognostic factor for sinus rhythm maintenance following DC cardioversion for atrial fibrillation

1. Left atrial emptying fraction was identified as an independent prognostic factor for sinus rhythm maintenance, following direct current cardioversion in atrial fibrillation patients

Evidence Rating Level: 2 (Good)

Atrial fibrillation (AF) refers to an irregular, rapid heartbeat due to improper electrical signalling in the heart’s atria. To restore sinus rhythm (SR) in AF patients, direct current cardioversion (DCCV) is often used. Although DCCV restores SR in 90% of individuals, only 70% continue to have SR maintained for 12 months afterwards. To assess the prognosis of SR maintenance, echocardiographic imaging is used to evaluate factors such as left atrium volume index (LAVI) and left atrium emptying fraction (LAEF). However, past research has focused on assessing these prognostic factors during SR, after DCCV is used to correct AF. The current prospective cohort study aimed to determine which factors are the best predictors for SR maintenance, even before DCCV is applied. The population consisted of 146 patients with persistent AF, lasting at least seven days, to be treated with DCCV. Numerous factors related to the electrical and mechanical aspects of the atria were measured through echocardiographic imaging, prior to DCCV. After 12 months, 41.8% of patients had SR maintained. The results found that LAEF was significantly greater in the SR maintenance group than the AF recurrence group (mean±SD = 30.8±8.3% vs 24.6±10.4%, p < 0.0001). Furthermore, out of all echocardiographic variables measured, only LAEF was found to be an independent predictor for SR maintenance following 12 months (odds ratio 1.046, 95% CI 1.000-1.095, p = 0.049). Overall, this study was the first to identify LAEF as an independent prognostic factor for SR maintenance 12 months after DCCV. Study findings identify LAEF as a potential prognostic factor that may aid clinicians in identifying patients who may have less success with SR maintenance after DCCV, and require additional cardiac interventions. 

Click to read the study in PlosONE

Image: PD

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