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European Heart Journal 2000 21(4):327-333; doi:10.1053/euhj.1999.1956
Copyright © 2000 by the European Society of Cardiology.
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Is there a place for the late cardioversion of atrial fibrillation?. A long-term follow-up study of patients with post-thyrotoxic atrial fibrillation

H Nakazawaa, D.A Lythallb, J Nohc, N Ishikawac, K Suginoc, K Itoc and S.M.C Hardmand,f1

a Department of Physiology, Tokai University Medical School, Japan
b Kent & Canterbury & St Thomas' Hospitals, U.K.
c Ito Hospital, Tokyo, Japan
d University College London Medical School and the UCL and Whittington Hospitals, London, U.K.

revised June 7, 1999; accepted June 9, 1999

Abstract

Aims As atrial fibrillation is associated with significant mortality and morbidity, restoration of sinus rhythm is desirable. However, previous data suggest that cardioversion should be restricted to patients in whom the fibrillation is of limited duration (<1–2 years) because of high relapse rates. It may be the frequent association with cardiac disease, rather than the duration of fibrillation itself, which determined the high relapse of earlier studies. The aim of this study was to investigate rates of cardioversion, maintenance of sinus rhythm and predictors of subsequent relapse in a homogeneous group of patients without evidence of any co-existent cardiac disease.

Methods and Results We report on a retrospective series of 106 patients with thyrotoxicosis-induced fibrillation but no other heart disease: 87% had been in atrial fibrillation for >12 months (median duration 28·5, interquartile range 15–47 months). Cardioversion was attempted using disopyramide and then electric shock. Ninety-eight patients were successfully cardioverted: at late follow-up, 80·6±37 months (mean±SD), 67% were in sinus rhythm.

Conclusion Although a relationship between the duration of fibrillation and maintenance of sinus rhythm was found, the high proportion remaining in sinus rhythm, compared with other series, suggests this influence may be less important than the presence or absence of structural heart disease.

Key Words: Longstanding atrial fibrillation, cardioversion, maintenance of sinus rhythm, disopyramide

f1 Correspondence: Dr S. M. C. Hardman, Clinical & Academic Department of Cardiovascular Medicine, University College London Medical School (Whittington Campus), St Mary's Wing, Whittington Hospital, Highgate Hill, London N19 5NF, U.K.

References

  1. Prystowsky EN, Benson W Jr, Fuster V. Management of patients with atrial fibrillation. Circulation. 1996;93:1262–1277[Free Full Text]
  2. Wheeldon NM. Atrial fibrillation and anticoagulation therapy. Eur Heart J. 1995;16:302–312[Free Full Text]
  3. Takkunen J, Oilinki O, Salokannel J, Vuopala U. Mortality of patients with atrial fibrillation before and after introduction of DC countershock therapy. Acta Med Scand. 1970;188:127–131
  4. Gajewski J, Singer RB. Mortality in an insured population with atrial fibrillation. JAMA. 1981;245:1540–1544[Abstract/Free Full Text]
  5. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiological features of atrial fibrillation: The Framingham study. N Engl J Med. 1982;306:1018–1022[Abstract]
  6. Cairns JA, Connolly SJ. Nonrheumatic Atrial Fibrillation. Risk of stroke and role of antithrombotic therapy. Circulation. 1991;84:469–481[Free Full Text]
  7. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–988[Abstract/Free Full Text]
  8. Pritchett ELC. Management of atrial fibrillation. N Engl J Med. 1992;326:1264–1271[Web of Science][Medline]
  9. World Health Statistics Annual 1994. Geneva: World Health Organisation; 1995.
  10. Channick BJ, Adlin EV, Marks AD. Hyperthyroidism and mitral-valve prolapse. N Engl J Med. 1981;305:497–500[Web of Science][Medline]
  11. Sanfilippo AJ, Abascal VM, Sheehan M. Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation. 1990;82:792–797[Abstract/Free Full Text]
  12. Nakazawa HK, Sakurai K, Hamada N, Momotani N, Ito K. Management of atrial fibrillation in the post-thyrotoxic state. Am J Med. 1982;72:903–906[CrossRef][Web of Science][Medline]
  13. Becker DV. Choice of therapy for Graves hyperthyroidism. N Engl J Med. 1984;311:464–466[Web of Science][Medline]
  14. Lown B, Amarasingham R, Neuman J. New method for terminating cardiac arrhythmias. JAMA. 1962;182:548–555[Abstract/Free Full Text]
  15. Nakazawa H, Ishikawa N, Noh J. Efficacy of disopyramide in conversion and prophylaxis of post-thyrotoxic atrial fibrillation. Eur J Clin Pharmacol. 1991;40:215–219[CrossRef][Web of Science][Medline]
  16. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481[CrossRef][Web of Science]
  17. Cox DR. Regression models and life-tables. JR Stat Soc (B). 1972;34:187–220
  18. Oram S, Davies JP. Further experience of electrical conversion of atrial fibrillation to sinus rhythm: analysis of 100 patients. Lancet. 1964;I:1294–1298
  19. Lown B. Electrical reversion of cardiac arrhythmias. Br Heart J. 1967;29:469–489[Free Full Text]
  20. Aberg H, Cullhed I. Direct current conversion of atrial fibrillation—long-term results. Acta Med Scand. 1968;184:433–440[Web of Science][Medline]
  21. Resnekov L, McDonald L. Complications in 220 patients with cardiac dysrhythmias treated by phased direct current shock, and indications for electroconversion. Br Heart J. 1967;29:926–936[Free Full Text]
  22. Szekely P, Sideris DA, Batson GA. Maintenance of sinus rhythm after atrial defibrillation. Br Heart J. 1970;32:741–746[Abstract/Free Full Text]
  23. Lundstrom T, Rydèn L. Chronic atrial fibrillation. Long-term results of direct current cardioversion. Acta Med Scand. 1988;223:53–59[Web of Science][Medline]
  24. Van Gelder IC, Crijns HJ, Van Gilst WH, Verwer R, Lie KI. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol. 1991;68:41–46[Web of Science][Medline]
  25. Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers T. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta analysis of randomized control trials. Circulation. 1990;82:1106–1116[Abstract/Free Full Text]
  26. Dittrich HC, Erickson JS, Scheiderman T, Blacky R, Savides T, Nicod PH. Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol. 1989;63:193–197[CrossRef][Web of Science][Medline]
  27. Hardman SMC, Noble MIM, Seed WA. Postextrasystolic potentiation and its contribution to the beat to beat variation of the pulse during atrial fibrillation. Circulation. 1992;86:1223–1232[Abstract/Free Full Text]
  28. Gosselink ATM, Blanksma PK, Crijns HJGM. Left ventricular beat to beat performance in atrial fibrillation: contribution of Frank-Starling mechanism after short rather than long RR intervals. J Am Coll Cardiol. 1995;26:1516–1521[Abstract]
  29. Woeber KA. Thyrotoxicosis and the heart. N Engl J Med. 1992;327:94–98[Abstract]
  30. Wijffels MCEF, Kirchhof CJHJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92:1954–1968[Abstract/Free Full Text]
  31. Moe GK. On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther. 1962;140:183–188[Web of Science]
  32. Allessie MA, Lammers WJEP, Bonke FIM. Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. Zipes DP, Jalife J. Cardiac Electrophysiology and Arrhythmias. Orlando: Grune & Stratton; 1986. p. 265–276
  33. N Engl J Med. 1989;321:1406–1412

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