The predictive value of transthoracic echocardiographic variables for sinus rhythm maintenance after electrical cardioversion of atrial fibrillation

Abstract

The recurrence rate of atrial fibrillation (AF) after successful electrical cardioversion (EC) is high, and the aim of the present study was to prospectively investigate in the randomized and placebo controlled CAPRAF (CAndesartan in the Prevention of Relapsing Atrial Fibrillation) population if echocardiographic variables at the day of EC could predict sinus rhythm maintenance. The study group consisted of 171 patients with persistent AF not given specific antiarrhythmic therapy; 137 had a successful EC and only 41 (30%) maintained sinus rhythm at 6 months follow-up. Transthoracic echocardiographic examination including measurements of the atria and left ventricle in addition to mitral inflow parameters, was performed within 4 h after successful EC. The use of the angiotensin II receptor antagonist candesartan had no influence on these echocardiographic parameters, neither on the recurrence rate of AF after EC. There were significant (p=0.05) lower transmitral A-wave velocities in the group with early relapsing AF compared to the group with sinus rhythm at 6 months follow-up (0.26 versus 0.30 m/s). All the patients (n=7) with the lowest A-wave velocities (=0.01 m/s) had an early recurrence of AF. There were no differences between the sinus rhythm maintenance and the relapsing AF groups regarding atrial dimensions or left ventricular function. In conclusion, our study demonstrates that only A-wave peak velocities at the day of EC were found to be significantly predictive of sinus rhythm maintenance 6 months after the procedure.