Handheld Ultrasound as a Novel Predictive Tool in Atrial Fibrillation: Prediction of Outcomes Following Electrical Cardioversion

Devin Kehl; Raymond Zimmer; Madhuri Sudan; Ilan Kedan

doi:10.2196/cardio.9534

Handheld Ultrasound as a Novel Predictive Tool in Atrial Fibrillation: Prediction of Outcomes Following Electrical Cardioversion

JMIR Cardio. 2018 Mar 8;2(1):e7. doi: 10.2196/cardio.9534.

Authors

Devin Kehl^#^{1

2}, Raymond Zimmer^#², Madhuri Sudan^{3

4

5}, Ilan Kedan^#²

Affiliations

¹ Palo Alto Foundation Medical Group, Palo Alto, California, CA, United States.
² Cedars Sinai Heart Institute, Beverly Hills, CA, United States.
³ Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, United States.
⁴ Department of Public Health, Aarhus University, Aarhus, Denmark.
⁵ College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States.

^# Contributed equally.

Abstract

Background: Atrial fibrillation (AF) recurrence after successful direct current cardioversion (CV) is common, and clinical predictors may be useful. We evaluated the risk of early AF recurrence according to inferior vena cava (IVC) measurements by handheld ultrasound (HHU) at the time of CV.

Objective: Assess HHU and objectively obtained measurements acquired at the point of care as potential clinical predictors of future clinical outcomes in patients with AF undergoing CV.

Methods: Maximum IVC diameter (IVCd) and collapsibility with inspiration were measured by the Vscan HHU (General Electric Healthcare Division) in 128 patients immediately before and after successful CV for AF. Patients were followed by chart review for recurrence of AF.

Results: Mean IVCd was 2.16 cm in AF pre-CV and 2.01 cm in sinus rhythm post-CV (P<.001). AF recurred within 30 days of CV in 34 of 128 patients (26.6%). Among patients with IVCd <2.1 cm pre-CV and decrease in IVCd post-CV, AF recurrence was 12.1%, compared to 31.6% in patients not meeting these parameters (odds ratio [OR] 0.299, P=.04). This association persisted after adjustment for age, ejection fraction <50%, left atrial enlargement, and amiodarone use (adjusted OR 0.185, P=.01). Among patients with IVCd post-CV <1.7 cm, AF recurrence was 13.5%, compared to 31.9% in patients not meeting this parameter (OR 0.185, P=.01). IVC parameters did not predict AF recurrence at 180 or 365 days.

Conclusions: The presence of a normal IVCd pre-CV that becomes smaller post-CV and the presence of a small IVCd post-CV were each independently associated with reduced likelihood of early, but not late, AF recurrence. HHU assessment of IVCd at the time of CV may be useful to identify patients at low risk of early recurrence of AF after CV.

Keywords: atrial fibrillation; cardioversion; hand held ultrasound; inferior vena cava; point of care; recurrence.

©Devin Kehl, Raymond Zimmer, Madhuri Sudan, Ilan Kedan. Originally published in JMIR Cardio (http://cardio.jmir.org), 08.03.2018.