Background: The early recurrence of atrial fibrillation(AF)after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. Methods: We evaluated ...Background: The early recurrence of atrial fibrillation(AF)after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. Methods: We evaluated patients in the AFFIRM study whose qualifying episode of AF lasted >48 hours and was terminated by cardioversion. Clinical, electrocardiographic, and echocardiographic risk factors associated with AF recurrence within 2 months of cardioversion and ≥ 2 cardioversions during the first year were identified using multivariate analysis in 1293 eligible patients. Results: The risk factors for the recurrence of AF within 2 months of cardioversion were no coronary artery disease and an electrocardiographic lead II P- wave duration of >135 milliseconds. In the subset of patients not taking antiarrhythmic drug therapy, the multivariate risk factors were no coronary artery disease, second or greater episode of AF, left ventricular ejection fraction< 0.50, and mitral valve thickening. Significant risk factors for the need for>2 cardioversions in the first year in patients taking antiarrhythmic medication were left atrial diameter >4.5 cm and mitral valve thickening. The overall sensitivity and specificity of these parameters for recurrence and repeated cardioversion are low. Conclusion: There are several risk factors for difficulty maintaining sinus rhythm after cardioversion of persistent AF. The clinical predictive value of these factors is low, and they probably should not be used to justify withholding rhythm control efforts in patients who might benefit from sinus rhythm.展开更多
Aims: Apelin is an endogenous peptide hormone that appears to have a physiological role in counter- regulation of the angiotensin and vasopressin systems. This peptide has been reported to be down- regulated in subjec...Aims: Apelin is an endogenous peptide hormone that appears to have a physiological role in counter- regulation of the angiotensin and vasopressin systems. This peptide has been reported to be down- regulated in subjects with acute heart failure, but has not been studied in other cardiovascular conditions. We studied apelin levels in 73 subjects with lone atrial fibrillation(AF). Methods and results: Study subjects had electrocardiographic evidence of paroxysmal or chronic AF and a structurally normal heart on echocardiography. Subjects were excluded if they had a history of coronary artery disease, rheumatic heart disease, cardiomyopathy, significant valvular disease, hyperthyroidism, or antecedent hypertension. Controls were recruited from a healthy outpatient population. Plasma apelin levels were determined using a commercially available immunoassay. Seventy- three subjects with lone AF and 73 healthy controls were enrolled and studied. Mean levels of apelin were significantly lower in subjects with lone AF when compared with controls(307 vs. 648 pg/mL, P < 0.00005). Conclusion: Reduced apelin levels were observed in this homogenous population of lone AF subjects and may represent an underlying diathesis predisposing to this common arrhythmia.展开更多
文摘Background: The early recurrence of atrial fibrillation(AF)after cardioversion and the need for frequent cardioversions to maintain sinus rhythm are important clinical features of AF management. Methods: We evaluated patients in the AFFIRM study whose qualifying episode of AF lasted >48 hours and was terminated by cardioversion. Clinical, electrocardiographic, and echocardiographic risk factors associated with AF recurrence within 2 months of cardioversion and ≥ 2 cardioversions during the first year were identified using multivariate analysis in 1293 eligible patients. Results: The risk factors for the recurrence of AF within 2 months of cardioversion were no coronary artery disease and an electrocardiographic lead II P- wave duration of >135 milliseconds. In the subset of patients not taking antiarrhythmic drug therapy, the multivariate risk factors were no coronary artery disease, second or greater episode of AF, left ventricular ejection fraction< 0.50, and mitral valve thickening. Significant risk factors for the need for>2 cardioversions in the first year in patients taking antiarrhythmic medication were left atrial diameter >4.5 cm and mitral valve thickening. The overall sensitivity and specificity of these parameters for recurrence and repeated cardioversion are low. Conclusion: There are several risk factors for difficulty maintaining sinus rhythm after cardioversion of persistent AF. The clinical predictive value of these factors is low, and they probably should not be used to justify withholding rhythm control efforts in patients who might benefit from sinus rhythm.
文摘Aims: Apelin is an endogenous peptide hormone that appears to have a physiological role in counter- regulation of the angiotensin and vasopressin systems. This peptide has been reported to be down- regulated in subjects with acute heart failure, but has not been studied in other cardiovascular conditions. We studied apelin levels in 73 subjects with lone atrial fibrillation(AF). Methods and results: Study subjects had electrocardiographic evidence of paroxysmal or chronic AF and a structurally normal heart on echocardiography. Subjects were excluded if they had a history of coronary artery disease, rheumatic heart disease, cardiomyopathy, significant valvular disease, hyperthyroidism, or antecedent hypertension. Controls were recruited from a healthy outpatient population. Plasma apelin levels were determined using a commercially available immunoassay. Seventy- three subjects with lone AF and 73 healthy controls were enrolled and studied. Mean levels of apelin were significantly lower in subjects with lone AF when compared with controls(307 vs. 648 pg/mL, P < 0.00005). Conclusion: Reduced apelin levels were observed in this homogenous population of lone AF subjects and may represent an underlying diathesis predisposing to this common arrhythmia.
