Predictors for Maintenance of Sinus Rhythm after Cardioversion in Patients with Non-valvular Atrial Fibrillation

Recurrence of atrial fibrillation (AF) after cardioversion (CV) is determined by various clinical and echocardiographic parameters. The purpose of this study was to determine the clinical and transesophageal echocardiographic (TEE) parameters predicting maintenance of sinus rhythm in patients with nonvalvular AF. One hundred and ten consecutive patients (56 men, 54 women, mean age 69 ± 9 years) who had been successfully converted to sinus rhythm and followed up at least 6 months were prospectively included in the study. Age, gender, the presence of diabetes, hypertension, coronary artery disease or chronic obstructive pulmonary disease, duration of AF, type of CV, configuration of the fibrillation wave on ECG were the clinical and left atrium diameter, left ventricular ejection fraction (EF), left atrium appendage (LAA) peak flow, LAAEF, pulmonary venous systolic and diastolic flows, the presence of LA spontaneous echo contrast, mitral ring calcification or mitral valve prolapses were the analysed transesophageal variables to predict recurrence of AF in 6 months that were evaluated on multiple stepwise logistic regression analysis. The patients were grouped into those reverted to AF in 6 months and in whom sinus rhythm was maintained longer. Fifty seven (%52) patients were still in sinus rhythm after 6 months from CV. LAAEF <30% was found to be the only independent variable (p<0.0012) predicting recurrence in 6 months after CV in patients with nonvalvular AF. It is concluded that TEE variables often used to determine thromboembolic risk may also be used to predict the outcome of CV.