K Apsite, A Strelnieks, I Pupkevica*, R Leibuss, IC Sproge, O Kalejs and A Lejnieks
Background: Atrial fibrillation has a high morbidity and mortality rate. It is the most common cardiac arrhythmia in humans. Restoring sinus rhythm by electrical cardio version is a first-line treatment of paroxysmal and persistent atrial fibrillation. Despite advances in the treatment strategies of patients with atrial fibrillation, the risk of recurrences one year after rhythm restoration is still over 50%.
Methods: This prospective study enrolled 150 patients with long-standing atrial fibrillation undergoing electrical cardioversion in Paul Stradins Clinical University Hospital. Anamnestic data was based on interviews and medical records. Standard transthoracic echocardiography was performed before electrical cardio version.
One year after sinus rhythm restoration with electrical cardio version using medical records and interview information about atrial fibrillation paroxysm during follow up period were obtained. At the end of follow up period was recorded electrocardiogram (ECG) for all patients.
Results: Normal diastolic function was found in 84(56%) patients, impaired relaxation, or dysfunction grade I in 45(30%), pseudo normalization or grade II in 21(14%), and there were any patients with dysfunction grade III. Statistically significant difference was found in atrial fibrillation relapses between patients with and without diastolic dysfunction (p 0.01).There were 47 patients with abnormal E/e′ (>8). 26 patients had atrial fibrillation relapse in one year after sinus rhythm restoration and it was not detected in 21 patients (p 0.04). In group with normal E/e′ (≤ 8) was 105 patients-18 with relapse and 85 without detected atrial fibrillation paroxysm (p>0.05).
Conclusion: Diastolic dysfunction and E/e′ are independent risk factors associated with atrial fibrillation recurrence after successful rhythm control attempt with electrical cardio version.
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