Early reccurence of atrial febrillation after transvenous atrial defibrillation

Abstract

Objective: In patients with atrial fibrillation (AF), restoration of sinus rhythm offers both hemodynamic and thromboembolic control, but may be limitted by early recurrence of AF (ERAF) after external or transvenous atrial defibrillation, (TAD). The purpose of this study was to assess the predictive value of some electrophysiological parameters ofr ERAF. Methods: Forty-two consecutive patients (30 males, 12 females, age 60±11 years) with AF underwent low energy TAD using R-wave synchronized biphasic shocks delivered from a custom external atrial defibrillator with step-up energy up to 400 Volts. Results: Successful termination of AF by TAD was achieved in all patients. However, ERAF (dennied as spontaneous reinititation of AF within 2 minutes after successful cardioversion) was observed in 12 patients (29%). Atrial premature contraction (APC) density defined as the number of APCs divided by the duration of sinus rhythm up to 2 minutes) was calculated and coupling time of APCs was measured for patients with ERAF and for those without. The mean duration for 53 episodes of sinus rhythm in 12 patients with ERAF was 19.0±17.3 seconds. Patients with ERAF bed significantly higher APC density than those without (8.7±11.9/min vs 2.5±2.2/min, P<0.001). Conclusion: TAD is effective in converting AF to sinus rhythm, but ERAF occurs about 30% in patients with chronic AF. APC density may be used as a predictor for ERAF and failure of restoration of sinus rhythm. The findings of this study indicate that APC suppression, either by electrical pacing and/or pharmacological intervention, may be necessary for maintenance of sinus rhythm after cardiovension.