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European Heart Journal Advance Access originally published online on June 7, 2006
European Heart Journal 2006 27(14):1755-1756; doi:10.1093/eurheartj/ehl069
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Clinical outcomes after direct current cardioversion of atrial tachyarrhythmias: reply

Ahmad A. Elesber

Division of Cardiovascular Diseases
Mayo Clinic
200 First Street SW
Rochester
MN 55905
USA

Virend Somers

Division of Cardiovascular Diseases
Mayo Clinic
200 First Street SW
Rochester
MN 55905
USA

Paul A. Friedman

Division of Cardiovascular Diseases
Mayo Clinic
200 First Street SW
Rochester
MN 55905
USA
E-mail address: friedman.paul{at}mayo.edu

David O. Hodge

Division of Biostatistics
Mayo Clinic
200 First Street SW
Rochester
MN 55905
USA

We greatly appreciate the interest of Arias and coworkers in our recent publication1 and their acknowledgement of our earlier studies relating to obstructive sleep apnoea (OSA) to the prevalence and recurrence of atrial fibrillation.2,3 The goal of our present study was to compare the arrhythmia relapse rate and mortality among patients who had new-onset atrial fibrillation or atrial flutter undergoing cardioversion with those of patients who had recurrent atrial fibrillation or atrial flutter. We agree that OSA likely has an important role in atrial fibrillation and other cardiovascular diseases. However, the logistics of conducting sleep studies in large numbers of patients coming to our cardioversion unit are daunting. Furthermore, at this time, we have no reason to suppose that the prevalence of OSA would be higher in new-onset vs. recurrent atrial tachyarrhythmias. In both groups, the prevalence of hypertension, which is often accompanied by OSA, was very similar. Arias and coworkers raise an interesting point that is very much in our general area of research emphasis. Nevertheless, the role of OSA in the findings from our study cannot be identified with any great accuracy. Furthermore, although we believe OSA to be very important in the development and prognosis of cardiac and vascular disease, this is a relatively new area of investigation and much needs to be done before cause-and-effect relationships between OSA and atrial fibrillation can be reliably defined.

References

  1. Elesber AA, Rosales AG, Herges RM, Shen W-K, Moon BS, Malouf JF, Ammash NM, Somers V, Hodge DO, Gersh BJ, Hammill SC, Friedman PA. (2006) Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly. Eur Heart J 27:854–860 Published online ahead of print February 2, 2006.[Abstract/Free Full Text]
  2. Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, Malouf JF, Ammash NM, Friedman PA, Somers VK. (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110:364–367 Published online ahead of print July 12, 2004.[Abstract/Free Full Text]
  3. Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, Shamsuzzaman AS, Somers VK. (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107:2589–2594 Published online ahead of print May 12, 2003.[Abstract/Free Full Text]

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