The predictive value of transthoracic echocardiographic variables for sinus rhythm maintenance after electrical cardioversion of atrial fibrillation. Results from the CAPRAF study, a prospective, randomized, placebo-controlled study.
OBJECTIVE
The recurrence rate of atrial fibrillation after electrical cardioversion is disappointingly high. The aim of the present study was to prospectively investigate if standard echocardiographic variables at the day of cardioversion could predict sinus rhythm maintenance.


METHODS
Transthoracic echocardiographic examination was performed within 4 h after cardioversion for all the patients in the CAPRAF (Candesartan in the Prevention of Relapsing Atrial Fibrillation) study.


RESULTS
Cardioversion was successful for 137 patients not given specific antiarrhythmic therapy, and only 41 (30%) maintained sinus rhythm at 6-month follow-up. There were significant (p = 0.05) lower transmitral A wave velocities in the group with relapsing atrial fibrillation compared with the group with sinus rhythm at 6-month follow-up. All patients with the lowest A wave velocities had an early recurrence of atrial fibrillation. There were no differences between the groups regarding atrial dimensions or left ventricular function. The use of the angiotensin II receptor antagonist candesartan had no influence on the echocardiographic variables, nor on the recurrence rate of atrial fibrillation after cardioversion.


CONCLUSIONS
Transthoracic echocardiographic examination performed a short time after electrical cardioversion of atrial fibrillation showed that only A wave peak velocities were significantly predictive of sinus rhythm maintenance 6 months after the procedure.
Grundvold
Irene
I
Department of Cardiology, Ullevål University Hospital, Oslo, Norway. irgr@uus.no
Tveit
Arnljot
A
Smith
Pål
P
Seljeflot
Ingebjørg
I
Abdelnoor
Michael
M
Arnesen
Harald
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy; D001562:Benzimidazoles / Q000627:therapeutic use; D001713:Biphenyl Compounds; D018619:Echocardiography, Doppler, Pulsed; D004554:Electric Countershock; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013777:Tetrazoles / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan