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(Chest. 2005;127:488-494.)
© 2005 American College of Chest Physicians

Prediction of Successful Cardioversion and Maintenance of Sinus Rhythm in Patients With Lone Atrial Fibrillation*

Ioannis A. Paraskevaidis, MD; Thomas Dodouras, MD; Dimitrios Tsiapras, MD and Dimitrios T. Kremastinos, MD

* From the Second Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.

Correspondence to: Ioannis A. Paraskevaidis, MD, Second Department of Cardiology, 356 Syngrou Ave, 176 74 Athens, Greece; e-mail: iparas{at}otenet.gr

Objective: We aimed to prospectively investigate the predictive value of echocardiographic parameters for the prediction of successful cardioversion and long-term sinus rhythm (SR) maintenance in patients who have experienced a lone episode of atrial fibrillation (AF).

Measurements and results: Clinical and echocardiographic data, including mean left atrial appendage (LAA) peak flow velocity and mitral annulus motion, were analyzed in 78 consecutive patients (mean [± SD] age, 59.3 ± 9.3 years) with AF lasting > 48 h and < 6 months. Sixty-one patients (78%) underwent successful external electrical cardioversion, while the remaining remained in AF. At the 1-year follow-up, of the 61 patients who had successfully been converted to SR, 24 (39.3%) remained in SR. For predicting the success of the cardioversion, we used a model consisting of two variables. LAA flow velocity (> 20 cm/s) and left ventricular (LV) fractional shortening (> 30%) appear to be quite strong, yielding 83.3% correct results. For predicting the maintenance of SR, we used a model consisting of two variables. The absence of the early systolic abnormal mitral annulus motion and LAA flow velocity (> 20 cm/s) appears to be quite strong, yielding 84.6% correct results. LAA flow velocity only marginally enters the model, and, if removed, little predictive value is lost (dropping to 83.3%). Removing the early systolic abnormal mitral annulus motion variable, the prediction value drops significantly to 70.5%.

Conclusion: LAA flow velocity combined with LV fractional shortening can predict the success of the conversion of AF to SR. Additionally, LAA flow velocity, combined with the analysis of mitral annulus motion before cardioversion, can predict the long-term maintenance of SR.

Key Words: atrial fibrillation • left atrial appendage flow • mitral annulus motion






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