Heart and Vessels

, Volume 21, Issue 6, pp 375–381

Long-term sinus rhythm maintenance after cardioversion of persistent atrial fibrillation: is the treatment's success predictable?

  • Dariusz A. Kosior
  • Marcin Szulc
  • Grzegorz Opolski
  • Adam Torbicki
  • Daniel Rabczenko


The aim of our study was to identify the clinical and echocardiographic predictors of long-term success of cardioversion in patients with persistent atrial fibrillation (AF). Our study comprised 104 patients (F/M 33/71; mean age 60.4 ± 7.9 years) assigned to SR restoration and maintenance with sequentially administered antiarrhythmic drugs. Their clinical and transthoracic echocardiographic (TTE) variables were recorded prior to cardioversion and examined for correlation with sinus rhythm (SR) maintenance at 1 year. The variables under consideration included age, gender, echo parameters such as long and short left atrial (LA) axis, LA and right atrial (RA) area, fractional shortening (FS) and left ventricular end-diastolic diameter, AF duration, New York Heart Association functional class, and concomitant diseases. Generalized additive logistic regression method was used to investigate impact of the selected variables on long-term SR maintenance. At 1 year, SR was present in 63.5% of patients. Left atrium area (LAar) > 28 cm (P < 0.02) and FS value >26% (P < 0.05), both measured at baseline, were significantly associated with SR maintenance after 1 year. Patients with large LAar values (>28 cm2) presented a significant decrease (31.45 ± 3.07 cm2 vs 28.94 ± 3.81 cm2; P < 0.008) during 30 days following SR maintenance. In patients with LAar >28 cm2 we noted an atrial decrease of 2.57 ± 3.2 cm2 (P < 0.004) during 30 days following SR restoration, which turned out to be an independent factor related to SR presence at 1 year of follow-up (relative risk 1.83; 95% confidence interval: 1.03–2.95; P < 0.01). Of all the considered variables only LA area and FS value seem to be relatively reliable predictors of SR sustainability at 1 year after an effective cardioversion of persistent AF.

Key words

Atrial fibrillation Electrocardioversion Sinus rhythm maintenance 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Feinberg, WM, Blackshear, JL, Laupacis, A,  et al. 1995Prevalence, age distribution and gender of patients with atrial fibrillation: analysis and implicationsArch Intern Med155469473PubMedCrossRefGoogle Scholar
  2. 2.
    Kannel, WB, Abbott, RB, Savage, DD,  et al. 1982Epidemiological features of chronic atrial fibrillation: the Framingham StudyN Engl J Med30610181022PubMedCrossRefGoogle Scholar
  3. 3.
    Langenberg, M, Hollemons, BSP, van Ree, JW,  et al. 1996Atrial fibrillation in elderly patients: prevalence and comorbidity in general practiceBr J Med31315341537Google Scholar
  4. 4.
    Coplen, SE, Antman, EM, Berlin, JA,  et al. 1990Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trialsCirculation8211061116PubMedGoogle Scholar
  5. 5.
    Kosior, DA Opolski, G Wożakowska-Kapłon, B Rabczenko, D for the Investigators of HOT CAFE Polish Trial2005Serial antiarrhythmic therapy: role of amiodarone in prevention of atrial fibrillation recurrence – a lesson from HOT CAFE Polish studyCardiology1043544PubMedCrossRefGoogle Scholar
  6. 6.
    Chung, MK Shemanski, L Sherman, DG for the AFFIRM Investigators et al. 2005Functional status in rate- versus rhythm-control strategies for atrial fibrillation: results of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Functional Status SubstudyJ Am Coll Cardiol4618911899PubMedCrossRefGoogle Scholar
  7. 7.
    Hohnloser, SF, Kuck, KH, Lilienthal, J,  et al. 2000Rhythm or rate control in atrial fibrillation – Pharmacological Intervention In Atrial Fibrillation (PIAF): a randomized trialLancet35617891794PubMedCrossRefGoogle Scholar
  8. 8.
    A comparison of rate control and rhythm control in patients with atrial fibrillation2002The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) InvestigatorsN Engl J Med34718251833CrossRefGoogle Scholar
  9. 9.
    Van Gelder, J, Hagens, VE, Bosker, HA,  et al. 2002A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillationN Engl J Med34718341840PubMedCrossRefGoogle Scholar
  10. 10.
    Opolski, G, Torbicki, A, Kosior, DA,  et al. 2004Trial. Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) studyChest126476486PubMedCrossRefGoogle Scholar
  11. 11.
    Carlsson, J, Miketic, S, Windeler, J,  et al. 2003Randomized trial of rate-control versus rhythm control in persistent atrial fibrillation. The Strategies of Treatment of Atrial Fibrillation (STAF) studyJ Am Coll Cardiol4116901696PubMedCrossRefGoogle Scholar
  12. 12.
    Laupacis, A, Albers, G, Dalen, J,  et al. 1995Antithrombotic therapy in atrial fibrillationChest108352359Google Scholar
  13. 13.
    Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-Dimenstional Echocardiography. Circulation 1980; 62:212–228Google Scholar
  14. 14.
    Hall, JI, Wood, DR 1968Factors affecting cardioversion of atrial arrhythmias with special reference to quinidineBr Heart J308490PubMedGoogle Scholar
  15. 15.
    Waris, E, Kreus, K, Salokannel, J,  et al. 1971Factors influencing the persistence of sinus rhythm after DC shock treatment of atrial fibrillationActa Med Scand189161166PubMedCrossRefGoogle Scholar
  16. 16.
    Brodsky, MA, Allen, BJ, Capparelli, EV,  et al. 1989Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatationAm J Cardiol6310651068PubMedCrossRefGoogle Scholar
  17. 17.
    Suttorp, MJ, Kingma, JH, Koomen, EM,  et al. 1993Recurrence of paroxysmal atrial fibrillation or flutter after successful cardioversion in patients with normal left ventricular functionAm J Cardiol71710713PubMedCrossRefGoogle Scholar
  18. 18.
    Brodsky, MA, Allen, BJ, Walker, CJ,  et al. 1987Amiodarone for maintenance of sinus rhythm after conversion of atrial fibrillation in the setting of dilated left atriumAm J Cardiol60572575PubMedCrossRefGoogle Scholar
  19. 19.
    Vitolo, E, Tronci, M, Larovere, MT,  et al. 1981Amiodarone versus quinidine in the prophylaxis of atrial fibrillationActa Cardiol86431444Google Scholar
  20. 20.
    Gold, RL, Haffajee, CI, Charos, G,  et al. 1986Amiodarone for refractory atrial fibrillationAm J Cardiol57124127PubMedCrossRefGoogle Scholar
  21. 21.
    Duytschaever, M, Haerynck, F, Tavernier, R,  et al. 1998Factors influencing long-term persistence of sinus rhythm after a first electrical cardioversion for atrial fibrillationPacing Clin Electrophysiol21284287PubMedCrossRefGoogle Scholar
  22. 22.
    Klein, AL, Grimm, RA, Black, IW,  et al. 1997Cardioversion guided by transesophageal echocardiography: the ACUTE pilot study, a randomized controlled trialAnn Intern Med126200209PubMedGoogle Scholar
  23. 23.
    Vaziri, SM, Larson, MG, Benjamin, EJ,  et al. 1994Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham StudyCirculation89724730PubMedGoogle Scholar
  24. 24.
    Furberg, CD, Psaty, BM, Manolio, TA,  et al. 1994For the CHS Collaborative Research Group. Prevalence of atrial fibrillation in elderly subjects (The Cardiovascular Health Study)Am J Cardiol74236241PubMedCrossRefGoogle Scholar
  25. 25.
    Henry, WL, Morganroth, J, Pearlman, AS,  et al. 1976Relation between echocardiographically determined left atrial size and atrial fibrillationCirculation53273279PubMedGoogle Scholar
  26. 26.
    Dethy, M, Chassat, C, Roy, D,  et al. 1988Doppler echocardiographic predictors of recurrence of atrial fibrillation after cardioversionAm J Cardiol62723726PubMedCrossRefGoogle Scholar
  27. 27.
    Suttorp, MJ, Kingma, JH, Koomen, EM,  et al. 1993Recurrence of paroxysmal atrial fibrillation or flutter after successful cardioversion in patients with normal left ventricular functionAm J Cardiol71710713PubMedCrossRefGoogle Scholar
  28. 28.
    Dittrich, HC, Erickson, JS, Schneiderman, T,  et al. 1989Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillationAm J Cardiol63193197PubMedCrossRefGoogle Scholar
  29. 29.
    Flugelman, MY, Hasin, Y, Katznelson, N,  et al. 1984Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosisAm J Cardiol54617619PubMedCrossRefGoogle Scholar
  30. 30.
    Van Gelder, IC, Crijns, HJGM, Van Glist, WH,  et al. 1991Prediction of eventful cardioversion and maintenance of sinus rhythm direct current cardioversion of chronic atrial fibrillation and flutterAm J Cardiol684146PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Dariusz A. Kosior
    • 1
  • Marcin Szulc
    • 2
  • Grzegorz Opolski
    • 1
  • Adam Torbicki
    • 3
  • Daniel Rabczenko
    • 4
  1. 1.I Chair and Department of CardiologyMedical University of WarsawWarsawPoland
  2. 2.Chair and Department of Internal Medicine and HypertensionMedical University of WarsawWarsawPoland
  3. 3.Department of Chest MedicineNational Institute of Tuberculosis and Pulmonary DiseasesWarsawPoland
  4. 4.Department of Medical StatisticsNational Institute of HygieneWarsawPoland

Personalised recommendations