SUCCESS OF ELECTIVE CARDIOVERSION IN PERSISTENT ATRIAL FIBRILLATION PATIENTS WITH OR WITHOUT DIASTOLIC DYSFUNCTION AS ASSESSED BY LEFT ATRIAL VOLUME INDEX

Abstract

Objective: To compare the success of elective electro-cardioversion of persistent AF patients presented with or without diastolic dysfunction as assessed by left atrial volume index (LAVI); and to compare the relationship between recurrence of AF after elective electro-cardioversion and LAVI.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from Jan to Aug 2018.

Material and Methods: Patients belonging to age group of 40 – 80 years, either gender, presenting with newly diagnosed non-valvular, persistent AF were prospectively enrolled in the study. Patients failed to achieve normal sinus rhythm after chemical cardio version of 3 weeks were identified to be candidates for electro-cardio version. Successful patients were followed up for six months to find out any recurrences by assessing their rhythm via electro cardiogram and physical/clinical examination.

Results: Elective electro-cardioversion was performed for 50 patients, with mean age of 58.1 ± 8.7 years (age range 42–75), 34 (68.0%) males and 16 (32.0%) females. Forty One (82.0%) patients achieved normal sinus rhythm following cardioversion. Univariate analysis of immediate success of cardioversion and LAVI showed that patients with LAVI of <30 ml/m2 are 1.4 times more likely to achieve normal sinus rhythm immediately after electro-cardioversion (OR=1.43, 95% CI=1.1–2.0, p-value 0.015). At the end of 6 months follow up, a total of 63.4% (n=26) patients had experienced recurrence of AF after electro-cardioversion.

Conclusion: Our study supports the fact that diastolic dysfunction assessed by LAVI is a significant predictor of immediate success of elective cardioversion in persistent AF patients, as well as recurrence of AF after successful cardioversion.