Abstract 9733: Atrial Fibrosis is Associated With Higher DC Cardioversion Failure Rates in Persistent Atrial Fibrillation

Abstract

Introduction: DC cardioversion (DCCV) is commonly performed in atrial fibrillation (AF). We examined the association between atrial fibrosis quantified using late gadolinium enhancement MRI (LGE-MRI) and acute success and recurrence of AF following DCCV. Methods: Persistent AF patients without previous catheter ablation who underwent LGE-MRI and DCCV were included in the study. Acute DCCV success was defined by achievement of sinus rhythm. Demographic patient data as well as comorbidities and medications were collected from chart revisions. Results: 241 patients were included (63% male). 186 patients (77.48%) were on oral anti-coagulation, 31 (12.9%) were on class I anti-arrhythmic drugs (AAD) and 46 (19.1%) were on class III AAD at the time of cardioversion. DCCV was acutely successful in 183 patients (75.9%). AF recurred after DCCV in 194 patients (80.5%) after an average follow up of 81 days. In univariate analysis, atrial fibrosis (HR 1.04; p=0.049) and body mass index (BMI) (HR 1.04; p=0.03) were associated with DCCV failure, while left atrial area, beta blocker, calcium channel blocker, class I and class III anti-arrhythmic drug use were not. In multivariate analysis, only atrial fibrosis was a significant predictor of DCCV failure (HR 1.03; p=0.03). During follow up, anti-arrhythmic drug use (class I drugs HR 0.21; p=0.045; class III drugs HR 0.27; p=0.042) was associated with maintenance of sinus rhythm. Conclusions: LGE-MRI quantified atrial fibrosis predicts failure of DCCV in persistent AF patients while AAD use was associated with maintenance of sinus rhythm.