Predictors of Failure Cardioversion for Recurrent Atrial Fibrillation Following Mitral Valve Surgery With Ablation
Electrical Cardioversion and Recurrent Atrial Fibrillation
Keywords:Electrical cardioversion, Atrial fibrillation, Recurrence, Predictors
Background: Electrical cardioversion (ECV) often is required for terminating recurrent atrial fibrillation (AF) after surgical radiofrequency ablation in patients undergoing mitral valve surgery. However, ECV is unsuccessful in some cases. In this study, we aimed to identify possible predictors of failed ECV for recurrent atrial fibrillation following mitral valve surgery with concomitant radiofrequency ablation.
Methods: We enrolled 1,136 persistent AF patients with history of mitral valve surgery and concomitant radiofrequency ablation. Three-hundred-nineteen patients experienced recurrence of persistent AF and received ECV therapy. Comparison was made between patients with failed ECV (Failure group, N = 68) and successful ECV (Success group, N = 251).
Results: In multivariate regression analysis, age, pre-ECV loading-dose amiodarone, left atrial diameter, atrial flutter and time from surgery to ECV were independent predictors for outcomes of ECV. According to receiver operating characteristic curve analysis, the best threshold values of age, left atrial diameter and time from surgery to ECV for predicting failed ECV were 55.5 years, 64.5 mm, and 90.5 days, respectively.
Conclusion: Older age, larger left atrium and longer time from surgery to ECV are independent predictors for failed ECV in this group. Compared with AF, atrial flutter is easier to be successfully terminated by ECV. Pre-ECV loading-dose amiodarone is helpful for successful ECV. These findings have important implications for identifying the kinds of patients to receive effective ECV.
Ad N, Henry L, Massimiano P, Pritchard G, Holmes SD. 2013. The state of surgical ablation for atrial fibrillation in patients with mitral valve disease. Curr Opin Cardiol 28:170-180.
Ad N, Holmes SD. 2014. Prediction of sinus rhythm in patients undergoing concomitant Cox maze procedure through a median sternotomy. J Thorac Cardiovasc Surg 148:881-886.
Ad N, Holmes SD, Massimiano PS, et al. 2013. The effect of the Cox-maze procedure for atrial fibrillation concomitant to mitral and tricuspid valve surgery. J Thorac Cardiovasc Surg 146:1426-1434.
Akdemir B, Altekin RE, Küçük M, et al. 2013. The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: a study on diagnostic accuracy. Anadolu Kardiyol Derg 13:18-25.
Calkins H, Brugada J, Packer DL, et al. 2007. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 4:816-861.
Casaclang-Verzosa G, Gersh BJ, Tsang TS. 2008. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol 51:1-11.
Crijns HJ, Van Gelder IC, Van Gilst WH, et al. 1991. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Am J Cardiol 68:335-341.
Crijns HJ, Weijs B, Fairley AM, et al. 2014. Contemporary real life cardioversion of atrial fibrillation: Results from the multinational RHYTHM-AF study. Int J Cardiol 172:588-594.
Ecker V, Knoery C, Rushworth G, et al. 2018. A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation. Clin Cardiol 41:862-870.
Gillinov AM, Gelijns AC, Parides MK, et al. 2015. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med 372:1399-1409.
Grönberg T, Hartikainen JE, Nuotio I, et al. 2015. Can we predict the failure of electrical cardioversion of acute atrial fibrillation? The FinCV study. Pacing Clin Electrophysiol 38:368-375.
Guo Y, Tian Y, Wang H, et al. 2015. Prevalence, incidence, and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation. Chest 147:109-119.
Ishii Y, Gleva MJ, Gamache MC, et al. 2004. Atrial tachyarrhythmias after the maze procedure: incidence and prognosis. Circulation 110:II164-168.
Marchese P, Bursi F, Delle Donne G, et al. 2011. Indexed left atrial volume predicts the recurrence of non-valvular atrial fibrillation after successful cardioversion. Eur J Echocardiogr 12:214-221.
Maroto LC, Carnero M, Silva JA, et al. 2011. Early recurrence is a predictor of late failure in surgical ablation of atrial fibrillation. Interact Cardiovasc Thorac Surg 12:681-686.
Ruel M, Kulik A, Lam BK, et al. 2005. Long-term outcomes of valve replacement with modern prostheses in young adults. Eur J Cardiothorac Surg 27:425-433.
van Breugel HN, Gelsomino S, de Vos CB, et al. 2014. Maintenance of sinus rhythm after electrical cardioversion for recurrent atrial fibrillation following mitral valve surgery with or without associated radiofrequency ablation. Int J Cardiol 175:290-296.
Van Gelder IC, Crijns HJ, Van Gilst WH, Verwer R, Lie KI. 1991. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol 68:41-46.
Voskoboinik A, Moskovitch JT, Harel N, et al. 2017. Revisiting pulmonary vein isolation alone for persistent atrial fibrillation: A systematic review and meta-analysis. Heart Rhythm 14:661-667.