Abstract 11863: History of Paroxysmal Atrial Fibrillation is Associated With Earlier Recurrence After Initial Cardioversion Compared to New-Onset Persistent Atrial Fibrillation

Abstract

Introduction: Recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV) for persistent AF is common. A preceding history of paroxysmal AF before persistent AF may predispose to recurrence of AF after DCCV. However, whether the absence of paroxysmal AF before new-onset persistent AF (primary persistent AF) affects the recurrence of AF is currently poorly defined. Hypothesis: Patients with persistent AF and a preceding history of paroxysmal AF will have a higher rate of recurrence after DCCV compared to patients with primary persistent AF. Methods: Prospective clinical database at a Veterans Hospital was used to compare recurrence rates of AF after initial DCCV in patients with primary persistent AF to patients with a history of prior paroxysmal AF. Results: Among 484 patients who underwent initial cardioversion for persistent AF, 21% had a history of paroxysmal AF (n = 101). 80% of patients with a history of paroxysmal AF had a recurrence within one year, compared to 58% of patients with a history of primary persistent AF (p=0.0001). Those with a history of paroxysmal AF had a smaller left atrium, 4.47 cm, compared to those with primary persistent AF, 4.64 cm (p=0.04) and were more likely to be taking anti-arrhythmic drugs (AAD) at the time of DCCV (p=0.00002). Although those with prior paroxysmal AF were more likely to have a history of CKD (p=0.03), OSA (p=0.0004), and CVA (p=0.001), the presence of these respective comorbidities did not affect recurrence rates (p=0.3055, 0.8253, 0.1689). Conclusions: Patients with prior paroxysmal AF were more likely to have a recurrence of AF after DCCV compared to patients without a history of primary persistent AF, despite smaller left atriums and higher rates of AAD use. Although those with prior paroxysmal AF had higher prevalence of CKD, OSA, and CVA, the presence of these comorbidities was not predictive of recurrence.