Left atrial emptying fraction determined during atrial fibrillation predicts maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation.

Paweł Wałek,Beata Wożakowska-Kapłon,Iwona Gorczyca,Janusz Sielski,Elena Cavarretta

doi:10.1371/journal.pone.0238002

Paweł Wałek, Beata Wożakowska-Kapłon + Show 3 more

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https://doi.org/10.1371/journal.pone.0238002

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Abstract

Echocardiography is the basic imaging technique used to determine the odds of maintaining sinus rhythm (SR) following direct current cardioversion (DCCV) for persistent atrial fibrillation (AF). However, most studies are focused on the echocardiographic parameters obtained during SR resulting from successful DCCV. The aim of this study was to assess the value of the echocardiographic parameters measured before DCCV for the prognosis of SR maintenance after DCCV. The study included 146 patients with persistent AF who underwent DCCV. Clinical and echocardiographic data were collected directly before DCCV and, for patients with SR, one month, six months, and 12 months after DCCV. We found that left atrial emptying fraction (LAEF) assessed during atrial fibrillation was significantly larger in the group with SR maintenance after 12 months than in the group with AF recurrence (30.8±8.3 vs. 24.6±10.4%; p<0.001). In multivariable logistic regression analysis with a model containing echocardiographic parameters, LAEF (OR 1.053; 95% CI 1.011-1.096; p = 0.013) and the E/e'mean ratio (OR 0.883; 95% CI 0.788-0.990; p = 0.033) were independent predictors of SR maintenance. Analyzing a model including clinical and echocardiographic variables, only LAEF (OR 1.046; 95% CI 1-1.095; p = 0.049) and beta-blockers used before DCCV (OR 14.694; 95% CI 1.622-133.139; p = 0.017) were independent predictors of SR maintenance after 12 months. Our results indicate that LAEF measured during AF is a significant predictor of SR maintenance in the 12 months following DCCV due to persistent AF. Our findings confirm the recently raised hypothesis about the superiority of echocardiographic parameters assessing mechanical remodeling over parameters assessing structural remodeling of left atrium in predicting sinus rhythm maintenance after electrical cardioversion.

Highlights

Atrial fibrillation (AF) is one of the most frequently diagnosed persistent supraventricular tachycardia [1] and one of the most common risk factors for cardiovascular diseases [2]
Our results indicate that LA emptying fraction (LAEF) measured during AF is a significant predictor of sinus rhythm (SR) maintenance in the 12 months following Direct current cardioversion (DCCV) due to persistent AF
There were no differences in age, body mass index (BMI), comorbidities, smoking habits, European Heart Rhythm Association (EHRA) scale, CHA2DS2-VASc scale, HAS-BLED scale, or the use of antiarrhythmic drugs, statins, or the renin–angiotensin–aldosterone system blockade therapy before and after DCCV

Summary

Introduction

Atrial fibrillation (AF) is one of the most frequently diagnosed persistent supraventricular tachycardia [1] and one of the most common risk factors for cardiovascular diseases [2]. The echocardiographic parameters most frequently mentioned as prognostic factors for SR maintenance are those assessing the structural remodeling of the left atrium, including the LA antero-posterior diameter (LAAP) and the LA volume index (LAVI); those assessing mechanical remodeling, such as the LA emptying fraction (LAEF) assessed during SR; and those assessing the left ventricular filling pressure (LVFP) [8,9,10,11,12,13,14,15,16,17,18,19]. Most studies have focused on the echocardiographic parameters measured during SR, following a successful DCCV. We measured the echocardiographic parameters before DCCV, during AF, and analyzed their potential in predicting SR maintenance

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