Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, sug...Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein(hs-CRP) was predictive of the outcome of cardioversion for AF. Methods and results: One hundred and six patients with a history of symptomatic AF lasting ≥ 1 day(age 63± 14 years, mean± S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients(79% ). By using selected cutoff values,multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF(AF duration≤ 36 days, odds ratio(OR), 0.98; 95% confidence interval(CI), 0.97-0.99), smaller left atrial diameter(left atrial diameter ≤ 40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction(left ventricular ejection fraction ≥ 60% , OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level(hs-CRP ≤ 0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140± 144 days, AF recurred in 64 patients(76% ). By using a cutoff value of hs-CRP ≥ 0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence(OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4% , respectively(log-rank test, p< 0.0001). Conclusions: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.展开更多
Background: The early recurrence of atrial fibrillation(AF)after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. Methods: We evaluated ...Background: The early recurrence of atrial fibrillation(AF)after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. Methods: We evaluated patients in the AFFIRM study whose qualifying episode of AF lasted >48 hours and was terminated by cardioversion. Clinical, electrocardiographic, and echocardiographic risk factors associated with AF recurrence within 2 months of cardioversion and ≥ 2 cardioversions during the first year were identified using multivariate analysis in 1293 eligible patients. Results: The risk factors for the recurrence of AF within 2 months of cardioversion were no coronary artery disease and an electrocardiographic lead II P- wave duration of >135 milliseconds. In the subset of patients not taking antiarrhythmic drug therapy, the multivariate risk factors were no coronary artery disease, second or greater episode of AF, left ventricular ejection fraction< 0.50, and mitral valve thickening. Significant risk factors for the need for>2 cardioversions in the first year in patients taking antiarrhythmic medication were left atrial diameter >4.5 cm and mitral valve thickening. The overall sensitivity and specificity of these parameters for recurrence and repeated cardioversion are low. Conclusion: There are several risk factors for difficulty maintaining sinus rhythm after cardioversion of persistent AF. The clinical predictive value of these factors is low, and they probably should not be used to justify withholding rhythm control efforts in patients who might benefit from sinus rhythm.展开更多
文摘Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein(hs-CRP) was predictive of the outcome of cardioversion for AF. Methods and results: One hundred and six patients with a history of symptomatic AF lasting ≥ 1 day(age 63± 14 years, mean± S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients(79% ). By using selected cutoff values,multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF(AF duration≤ 36 days, odds ratio(OR), 0.98; 95% confidence interval(CI), 0.97-0.99), smaller left atrial diameter(left atrial diameter ≤ 40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction(left ventricular ejection fraction ≥ 60% , OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level(hs-CRP ≤ 0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140± 144 days, AF recurred in 64 patients(76% ). By using a cutoff value of hs-CRP ≥ 0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence(OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4% , respectively(log-rank test, p< 0.0001). Conclusions: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.
文摘Background: The early recurrence of atrial fibrillation(AF)after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. Methods: We evaluated patients in the AFFIRM study whose qualifying episode of AF lasted >48 hours and was terminated by cardioversion. Clinical, electrocardiographic, and echocardiographic risk factors associated with AF recurrence within 2 months of cardioversion and ≥ 2 cardioversions during the first year were identified using multivariate analysis in 1293 eligible patients. Results: The risk factors for the recurrence of AF within 2 months of cardioversion were no coronary artery disease and an electrocardiographic lead II P- wave duration of >135 milliseconds. In the subset of patients not taking antiarrhythmic drug therapy, the multivariate risk factors were no coronary artery disease, second or greater episode of AF, left ventricular ejection fraction< 0.50, and mitral valve thickening. Significant risk factors for the need for>2 cardioversions in the first year in patients taking antiarrhythmic medication were left atrial diameter >4.5 cm and mitral valve thickening. The overall sensitivity and specificity of these parameters for recurrence and repeated cardioversion are low. Conclusion: There are several risk factors for difficulty maintaining sinus rhythm after cardioversion of persistent AF. The clinical predictive value of these factors is low, and they probably should not be used to justify withholding rhythm control efforts in patients who might benefit from sinus rhythm.
