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Europace 2004 6(3):229-235; doi:10.1016/j.eupc.2004.01.006
© 2004 by European Society of Cardiology
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Temporal changes in atrial refractoriness following DC cardioversion of persistent atrial fibrillation in man

Philip Spurrella,*, Kayvan Kamalvandb, Mike Higsona and Neil Sulkea

aDepartment of Cardiology, Eastbourne General Hospital King's Drive, Eastbourne, East Sussex, BN21 2UD, UK; bDepartment of Cardiology, William Harvey Hospital Ashford, Kent, UK

AIMS: Studies have demonstrated shortening of the atrial effective refractory period (ERP) after episodes of atrial fibrillation (AF). This is termed atrial remodelling. It is unclear whether restoration of SR after persistent AF in patients with a clinical substrate results in reversal of this shortening and whether this is maintained long term.

METHODS AND RESULTS: The ERP was determined at mid-lateral right atrial wall (MLRA) and right atrial appendage (RAA) at 600 ms and 400 ms drive cycle lengths and at basic sinus cycle length in 81 patients with persistent AF immediately, 24 h and 2 weeks following external DC cardioversion. All atrially active drugs were stopped for at least 5 half lives. (1) Prolongation of the ERP was observed at both atrial sites and all cycle lengths up to 24 h post cardioversion (p<0.0001). (2) However, between 24 h and 2 weeks a subsequent shortening occurred in the ERP returning it to near post cardioversion levels. (3) The ERP was significantly longer at 24 h post cardioversion in patients who remained in SR for 2 weeks or longer compared with those who reverted to AF.

CONCLUSION: Prolongation of the atrial ERP occurred following restoration of SR in persistent AF patients but was not maintained and displayed a biphasic pattern such that by 2 weeks the ERP had returned to baseline values. Despite this finding, a longer ERP at 24 h post cardioversion was associated with maintenance of SR in the medium-term.

Key Words: atrial fibrillation, atrial electrophysiology, cardioversion

*Corresponding author. Tel./fax: +44-1626-821081. E-mail address: spurrellp{at}aol.com (P. Spurrell).


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