O.S. Sychov, A.O. Borodai, L.L. Vavilova. Myocardial remodeling after cardioversion and predictors of rhythm control in patients with persistent atrial fibrillation of non-valvular origin

The aim – to assess myocardial remodeling after cardioversion and to evaluate predictors of rhythm control during follow-up of 21 month.

Material and methods. In prospective longitudinal study consecutive 95 patients were enrolled before cardioversion. Patients with history of paroxysmal atrial fibrillation (AF) just before current episode, permanent AF, unstable or acute heart failure, severe valvular diseases and rheumatic heart disease, recent open-heart surgery, major disorders, or an unsuccessful cardioversion were excluded. Transthoracic echocardiography was performed to all patients at the beginning and at the end of the study. Transoesophageal echocardiography was performed for all patients at the beginning of the study and only for a group with recurrent AF at the end of the study.

Results. At the end of follow-up of 21 months maintenance of SR was achieved in 52 (54.7 %) of patients. Patients with sinus rhythm had significantly higher left ventricular ejection fraction, smaller left atrial and right atrial volume indices comparing to patients before cardioversion. They also had milder severity of functional mitral regurgitation and better NYHA class. In univariate Cox’s-F test with rhythm control associated: age ≥ 65 y.o. (Р=0.003), use of amiodarone (Р<0.001), use of ACE/ARB (Р<0.001), septal thickness < 1.7 cm (Р=0.01), left atrial volume index < 48 ml/m2 (Р=0.04), and ∆EF2 – EF1 ≥ 10 % (Р=0.004). On the other hand, first diagnosed AF (Р=0.3), use of statins (Р=0.07), Em > 8 cm/s (Р=0.3), EF ≥ 40 % (Р=0.08), were not associated with sinus rhythm maintenance. In multivariate regression model we found that the use of amiodarone (Р=0.01), ACE/ARB (Р=0.02), age ≥ 65 y.o. (Р=0.03), septal thickness < 1.7 cm (Р=0.02), but not the ejection fraction ≥ 40 % (Р=0.14) and left atrial volume index < 48 ml/m2 (Р=0.07) were independently associated with rhythm control. Conclusions. Rhythm control was associated with significantly lower class NYHA, and myocardial remodeling which primarily included reduction of atrial volumes, improvement in left ventricular systolic function and reduction of mitral regurgitation severity. Use of amiodarone, ACE/ARB, age ≥ 65 y.o., septal thickness < 1.7 cm, but not the ejection fraction ≥ 40 % and left atrial volume index < 48 ml/m2 were independently associated with rhythm control.

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