Clinical Research in Cardiology

, Volume 96, Issue 2, pp 103–108 | Cite as

The prognostic impact of successful cardioversion of atrial fibrillation in patients with organic heart disease

  • Thomas Kleemann
  • Torsten Becker
  • Klaus Dönges
  • Margit Vater
  • Bern Gut
  • Steffen Schneider
  • Jochen Senges
  • Karlheinz Seidl
ORIGINAL PAPER

Summary

The aim of the study was to evaluate the prognostic impact of successful cardioversion (CV) compared to failed CV in patients with atrial fibrillation (AF) and organic heart disease. A total of 471 consecutive patients with organic heart disease from the prospective single center anticoagulation registry ANTIK who underwent CV of AF or atrial flutter were analyzed. 417 patients (89%) could be successfully cardioverted. In 54 patients (11%) CV failed, these patients remained in AF. After 5 years there were 92 (24%) deaths among patients with restored sinus rhythm at index admission and 20 (38%) deaths among those who remained in AF after CV (unadjusted OR 1.9, 95% CI 1.1–3.6). After adjustment for age, gender and ejection fraction, successful CV was not associated with a beneficial effect on mortality (OR 0.72, 95% CI 0.43–1.21). Thus, successful CV is not an independent predictor of mortality on multivariate analysis. However, it remains a marker for a better prognosis in patients with organic heart disease as these patients have a lower unadjusted longterm mortality.

Key words

Atrial fibrillation cardioversion prognosis 

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References

  1. 1.
    Benjamin EJ, Wolf PA, D‘Agostino RB et al (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946–952PubMedGoogle Scholar
  2. 2.
    Bernhardt P, Schmidt H, Sommer T, Lüderitz B, Omran H (2006) Atrial fibrillation: patients at high risk for cerebral embolism. Clin Res Cardiol 95(3):148–153PubMedCrossRefGoogle Scholar
  3. 3.
    Blackshear JL, Safford RE (2003) AFFIRM and RACE trials: implications for the management of atrial fibrillation. Card Electrophysiol Rev 7(4):366–399PubMedCrossRefGoogle Scholar
  4. 4.
    Boldt A, Scholl A, Garbade M et al (2006) ACE-inhibitor treatment attenuates atrial structural remodeling in patients with lone atrial fibrillation. Basic Res Cardiol 101(3):261– 267PubMedCrossRefGoogle Scholar
  5. 5.
    Carson PE, Johnson GR, Dunkman WB et al (1993) The influence of atrial fibrillation on prognosis in mild to moderate heart failure: the VHeFT Studies. Circulation 87:VI-102–VI-110Google Scholar
  6. 6.
    Corley SD, Epstein AE, DiMarco JP et al (2004) Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 109(12):1509–1513PubMedCrossRefGoogle Scholar
  7. 7.
    Daoud EG, Weiss R, Bahu M et al (1996) Effect of an irregular ventricular rhythm on cardiac output. Am J Cardiol 78:1433–1436PubMedCrossRefGoogle Scholar
  8. 8.
    Dries DL, Exner DV, Gersh BJ et al (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials: Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 32:695–703PubMedCrossRefGoogle Scholar
  9. 9.
    Gage BF, Van Walraven C, Pearce L et al (2004) Selecting patients with atrial fibrillation for anticoagulation. Circulation 110:2287–2292PubMedCrossRefGoogle Scholar
  10. 10.
    Gowda RM, Khan IA, Punukollu G et al (2004) Female preponderance in ibutilide-induced torsade de pointes. Int J Cardiol 95(2–3):219–222PubMedCrossRefGoogle Scholar
  11. 11.
    Kaufman ES, Zimmermann PA, Wang T et al (2004) Risk of proarrhythmic events in the trial Fibrillation Followup Investigation of Rhythm Management (AFFIRM) study: a multivariate analysis. J Am Coll Cardiol 44(6):1276–1282PubMedGoogle Scholar
  12. 12.
    Krahn AD, Manfreda J, Tate RB et al (1995) The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up study. Am J Med 98:476–484PubMedCrossRefGoogle Scholar
  13. 13.
    Li D, Shinagawa K, Pang L et al (2001) Effects of angiotensin-converting enzyme inhibition on the development of the atrial fibrillation substrate in dogs with ventricular tachypacing- induced congestive heart failure. Circulation 104:2608–2614PubMedGoogle Scholar
  14. 14.
    Obergassel L, Lawrenz T, Gietzen FH et al (2006) Effect of transcoronary ablation of septal hypertrophy on clinical outcome in hypertrophic obstructive cardiomyopathy associated with atrial fibrillation. Clin Res Cardiol 95(5):254–260PubMedCrossRefGoogle Scholar
  15. 15.
    Olsson LG, Swedberg K, Ducharme A et al (2006) Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction. J Am Coll Cardiol 47:1997–2004PubMedCrossRefGoogle Scholar
  16. 16.
    Reiffel JA (1998) Impact of structural heart disease on the selection of class III antiarrhythmics for the prevention of atrial fibrillation and flutter. Am Heart J 135:551–556PubMedCrossRefGoogle Scholar
  17. 17.
    Ricci RP, Russo M, Santini M (2006) Management of atrial fibrillation: what are the possibilities of early detection with Home Monitoring? Clin Res Cardiol 95(Suppl 3):iii10–iii16PubMedCrossRefGoogle Scholar
  18. 18.
    Sanders P, Morton JB, Davidson NC et al (2003) Electrical remodeling of the atria in congestive heart failure: electrophysiological and electroanatomic mapping in humans. Circulation 108:1461–1468PubMedCrossRefGoogle Scholar
  19. 19.
    Sparks PB, Mond HG, Vohra JK et al (1999) Electrical remodeling of the atria following loss of atrioventricular synchrony: a long-term study in humans. Circulation 100:1894–1900PubMedGoogle Scholar
  20. 20.
    Steinberg JS, Sadaniantz A, Kron J et al (2004) Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation 109(16):1973–1980PubMedCrossRefGoogle Scholar
  21. 21.
    The AFFIRM Investigators (2002) Survival of patients presenting with atrial fibrillation in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. N Engl J Med 347:1825–1833CrossRefGoogle Scholar
  22. 22.
    The AFFIRM investigators (2002) Baseline characteristics of patients with atrial fibrillation: the AFFIRM Study. Am Heart J 143:991–1001CrossRefGoogle Scholar
  23. 23.
    Van Gelder IC, Hagens VE, Bosker HA et al (2002) A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834–1840PubMedCrossRefGoogle Scholar
  24. 24.
    Wolbrette D (2002) Gender differences in the proarrhythmic potential of QT-prolonging drugs. Curr Womens Health Rep 2(2):105–109PubMedGoogle Scholar
  25. 25.
    Wolf PA, Abbott R, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 22:983–988PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • Thomas Kleemann
    • 1
  • Torsten Becker
    • 1
  • Klaus Dönges
    • 1
  • Margit Vater
    • 1
  • Bern Gut
    • 1
  • Steffen Schneider
    • 1
  • Jochen Senges
    • 1
  • Karlheinz Seidl
    • 1
  1. 1.Herzzentrum Ludwigshafen, Klinikum LudwigshafenMedizinische Klinik BLudwigshafenGermany

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