Risk Factors of Early Atrial Fibrillation Recurrence Following Electrical Cardioversion When Left Ventricular Ejection Fraction Is Preserved

Rasa Karaliūtė; Arnoldas Leleika; Ieva Apanavičiūtė; Tomas Kazakevičius; Vaida Mizarienė; Vytautas Zabiela; Aušra Kavoliūnienė; Nijolė Ragaišytė; Daiva Urbonienė; Gintarė Šakalytė

doi:10.3390/medicina58081053

Risk Factors of Early Atrial Fibrillation Recurrence Following Electrical Cardioversion When Left Ventricular Ejection Fraction Is Preserved

Medicina (Kaunas). 2022 Aug 4;58(8):1053. doi: 10.3390/medicina58081053.

Authors

Rasa Karaliūtė^{1

2

3}, Arnoldas Leleika^{3

4}, Ieva Apanavičiūtė⁴, Tomas Kazakevičius^{2

3}, Vaida Mizarienė^{2

3}, Vytautas Zabiela^{2

3

5}, Aušra Kavoliūnienė^{2

3}, Nijolė Ragaišytė^{2

3}, Daiva Urbonienė⁶, Gintarė Šakalytė^{2

3

5}

Affiliations

¹ Laboratory of Behavioural Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania.
² Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania.
³ Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania.
⁴ Medicine Faculty, Medicine Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania.
⁵ Institute of Cardiology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania.
⁶ Department of Laboratory Medicine, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania.

Abstract

Background and objectives: To identify clinical, echocardiographic, and laboratory parameters that affect the early recurrence of atrial fibrillation (AF) after restoring sinus rhythm (SR) by electrical cardioversion (ECV), and to determine whether left atrial (LA) strain, as a noninvasive indicator reflecting fibrosis, is associated with laboratory indicators affecting the development of fibrosis, interleukin 6 (IL-6) or tumor necrosis factor α (TNF-α). Materials and Methods: The study included 92 persistent AF patients who underwent elective ECV. The effective maintenance of SR was evaluated after 40 ± 10 days of ECV. Echocardiography, inflammatory markers (high-sensitivity c-reactive protein (hs-CRP), IL-6, and TNF-α), and natriuretic peptides (N-terminal pro b-type natriuretic peptide (NT-proBNP) and N-terminal pro a-type natriuretic peptide (NT-proANP)) were assessed. Results: After a 40 ± 10 days observation period, 51 patients (55.4%) were in SR. Patients with AF recurrence had a significantly longer duration of AF (p = 0.008) and of arterial hypertension (p = 0.035), lower LA ejection fraction (p = 0.009), lower LA strain (p < 0.0001), higher left ventricular global longitudinal strain (p = 0.001), and a higher E/e‘ ratio (p < 0.0001). LA strain was an independent predictor of early AF recurrence (OR: 0.65; 95% Cl 0.5−0.9, p = 0.004). LA strain < 11.85% predicted AF recurrence with 70% sensitivity and 88% specificity (AUC 0.855, 95% CI 0.77−0.94, p < 0.0001). LA strain demonstrated the association with NT-proBNP (r = −0.489, p < 0.0001) and NT-proANP (r = −0.378, p = 0.002), as well as with hs-CRP (r = −0.243, p = 0.04). Conclusions: LA strain appeared to be the most accurate predictor of early AF recurrence after ECV in patients with persistent AF. LA strain inversely correlated with NT-proBNP and NT-proANP, but no significant association with any of the inflammatory markers was identified.

Keywords: atrial fibrillation; biomarkers; cardioversion; fibrosis; inflammatory; left atrial strain; natriuretic peptides.

MeSH terms

Atrial Fibrillation* / therapy
Biomarkers
C-Reactive Protein / analysis
Electric Countershock*
Fibrosis
Humans
Interleukin-6
Natriuretic Peptides
Recurrence
Risk Factors
Stroke Volume
Tumor Necrosis Factor-alpha
Ventricular Function, Left

Substances

Biomarkers
Interleukin-6
Natriuretic Peptides
Tumor Necrosis Factor-alpha
C-Reactive Protein

Grants and funding

This research was funded by Kaunas Region Society of Cardiology.