Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion.
OBJECTIVE
Although electrical cardioversion (CV) is effective in restoring sinus rhythm in patients with atrial fibrillation (AF), AF frequently recurs in spite of antiarrhythmic medications. We investigated the predictors of failed CV and AF recurrence after successful CV.


RESULTS
In 81 patients (M:F = 63:18, 59.1 +/- 10.5 years old) with AF who underwent CV, clinical, image, and CV findings (energy requirement, immediate recurrence of AF < 15 min), and pre-CV serological markers were evaluated.


RESULTS
(i) During 13.1 +/- 10.6 months of follow-up, 8.6% (7/81) showed failed CV, 59.26% (48/81) showed AF recurrence, and 32.1% (26/81) remained in sinus rhythm (no recurrence). (ii) Failed CV showed higher plasma levels of transforming growth factor (TGF)-beta (P = 0.0260) than those with successful CV. (iii) Patients with AF recurrence were older (60.4 +/- 9.0 years old vs. 55.3 +/- 12.5 years old, P = 0.0220), had a higher incidence of spontaneous echo contrast (SEC; 68.1 vs. 40.0%, P = 0.0106), a lower prescription rate of angiotensin-converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB; 27.0 vs. 50.0%, P = 0.0248) or spironolactone (0.0 vs. 19.2%, P = 0.0007), and lower plasma levels of stromal cell-derived factor (SDF)-1alpha (P = 0.0105).


CONCLUSIONS
Post-CV recurrence commonly occurs in patients with age >60 years, SEC, under-utilization of ACE-I/ARB or spironolactone, and low plasma levels of SDF-1alpha. High plasma level of TGF-beta predicts failed CV.
Yonsei University Health System, Seoul, Republic of Korea.
Sook Kyoung
SK
Kim
Hui-Nam
HN
Pak
Jae Hyung
JH
Park
Kyoung Jeong
KJ
Ko
Jihei Sara
JS
Lee
Jong Il
JI
Choi
Dong Hoon
DH
Choi
Young-Hoon
YH
Kim
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D015415:Biomarkers