Predictors of recurrence after electrical cardioversion of AF

Predictors of recurrence after electrical cardioversion of AF

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Electrical cardioversion is an established method of restoration of sinus rhythm. But recurrence of atrial fibrillation after successful electrical cardioversion is not uncommon. Following are the important predictors of recurrence after electrical cardioversion of AF:

  1. Duration of atrial fibrillation – longer the duration, higher the chance of recurrence as the atria would have remodeled structurally and electrically to sustain atrial fibrillation.
  2. Age of the person – prevalence of atrial fibrillation increases as advances and so does the chance of recurrence after cardioversion.
  3. Left atrial size – larger the left atrial size, higher the chance of maintaining multiple reentrant circuits and higher the chance of recurrence of atrial fibrillation.
  4. Left ventricular dimensions – dilated left ventricle would mean a failing left ventricle and hence associated left atrial dilatation.
  5. Left ventricular ejection fraction – lower left ventricular ejection fraction is associated with dilated left atrium.
  6. Underlying cardiac disease
  7. NYHA functional class – poorer the functional class, higher the chance of recurrence
  8. Previous relapses of atrial fibrillation

In a study the mitral E/e’ ratio determined by tissue Doppler echocardiography has been shown to be a good predictor of recurrence in those with left atrial dilatation [1]. A ratio above 11 predicts increased left ventricular filling pressures and hence the chance of recurrence of atrial fibrillation. In this study, duration of AF more than 3 months was also an important predictor of recurrence.

Reference

  1. Fornengo C, Antolini M, Frea S, Gallo C, Grosso Marra W, Morello M, Gaita F. Prediction of atrial fibrillation recurrence after cardioversion in patients with left-atrial dilation. Eur Heart J Cardiovasc Imaging. 2015 Mar;16(3):335-41.