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Europace Advance Access published online on October 26, 2009
Europace, doi:10.1093/europace/eup321
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

CLINICAL RESEARCH

Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion

Sook Kyoung Kim1, Hui-Nam Pak1,*, Jae Hyung Park1, Kyoung Jeong Ko2, Jihei Sara Lee2, Jong Il Choi2, Dong Hoon Choi1 and Young-Hoon Kim2

1 Yonsei University Health System, Seoul, Republic of Korea; 2 Korea University Cardiovascular Center, Seoul, Republic of Korea

Aims: 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.

Methods and 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)-β (P = 0.0260) than those with successful CV. (iii) Patients with AF recurrence were older (60.4 ± 9.0 years old vs. 55.3 ± 12.5years 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)-1{alpha} (P = 0.0105).

Conclusion: 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-1{alpha}. High plasma level of TGF-β predicts failed CV.

Key Words: Atrial fibrillation, Electrical cardioversion, Recurrence, Predictor

* Corresponding author. Tel: +82 2 2228 8459, Fax: +82 2 393 2041, Email: hnpak{at}yuhs.ac

Manuscript submitted 6 June 2009. Accepted after revision 23 September 2009.


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