title: Recurrence of atrial fibrillation after internal cardioversion of persistent atrial fibrillation: prognostic importance of electrophysiologic parameters.
abstract: BACKGROUND
  The purpose of this study was to determine whether the extent of atrial electrical remodeling affects the recurrence of atrial fibrillation (AF) after cardioversion of persistent AF (PAF).
  
  
  RESULTS
  Internal atrial cardioversion was performed in 47 patients with PAF. The right atrial monophasic action potential duration (RA-MAPD) at pacing cycle lengths (PCLs) of 800-300 ms and P wave signal-averaged electrocardiogram were recorded after cardioversion. Bepridil (150-200 mg/day) and carvedilol (10 mg/day) were administered to all patients after cardioversion. Of the 47 patients, 20 had recurrent AF within 3 months. No relation was observed between age, left atrial dimension, left ventricular ejection fraction, and AF recurrence. The AF duration was significantly longer (p<0.05) and RA-MAPD at PCLs of 800 to 300 ms were significantly shorter (p<0.05) in patients with AF recurrence than in those without recurrence. The mean slope of the RA-MAPD for PCLs between 600 and 300 ms did not differ between the patients with and without AF recurrence. The filtered P-wave duration (FPD) was significantly longer in the patients with AF recurrence than in those without (p<0.05). Multivariate analysis also showed that the RA-MAPD at a PCL of 300 ms and FPD were predictors of AF recurrence (RAMAPD: p=0.038; FPD: p=0.052).
  
  
  CONCLUSIONS
  These results suggest that electrical remodeling related to the repolarization and depolarization may be the main contributors to early AF recurrence after cardioversion under the administration of bepridil and carvedilol.
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Okumura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.forename: Toshiko
authors.initials: T
authors.lastname: Nakai
authors.forename: Hidezou
authors.initials: H
authors.lastname: Sugimura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Riko
authors.initials: R
authors.lastname: Masaki
authors.forename: Kimie
authors.initials: K
authors.lastname: Ohkubo
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takagi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shindo
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Saito
authors.forename: Katsuo
authors.initials: K
authors.lastname: Kanmatsuse
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D015764:Bepridil / Q000008:administration & dosage; D002227:Carbazoles / Q000008:administration & dosage; D000077261:Carvedilol; D004554:Electric Countershock; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011412:Propanolamines / Q000008:administration & dosage; D012008:Recurrence; D012307:Risk Factors
chemical_list: D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D015764:Bepridil