ABSTRACT
Atrial fibrillation (AF) is the most common arrhythmia in humans. After successful cardioversion, there is a recurrence of 60% due to atrial remodeling, and it has been shown that the global peak atrial longitudinal strain (GPALS) is decreased in these subjects. The aim of this study was to evaluate the predictive value of GPALS for AF recurrence. A prospective cohort of patients with persistent (PnVAF) and long standing persistent non-valvular AF (LSPnVAF) which underwent electrical cardioversion was evaluated with standard echocardiographic variables and GPALS quantification. The primary endpoint was AF recurrence at 6 months. We included PnVAF (n = 50, aged 68.4 ± 10.2 years, female 46%, lasted AF 6 months) and LSPnVAF (n = 81, aged 66.5 ± 13.1 years, female 36%, lasted AF 18 months). At 6 months there were a 68% of recurrence of AF in PnVAF and 53% in LSPnVAF group. GPALS was lower in recurrence 7.8 ± 2.0% versus 21.2 ± 8.9% (p < 0.001) for PnVAF and 7.3 ± 2.7% versus 20.7 ± 7.6% (p < 0.001) in LSPnVAF. GPALS ≤ 10.75% discriminates recurrence at 6 months with a sensitivity of 85%, specificity 99%, PPV 85%, NPV 90%, LR + 8.5 and LR- 0.17. The independent predictors of recurrence in PnVAF were GPALS ≤ 10.75% HR 8.89 [(2.2-35.7), p < 0.01] meanwhile in LSPnVAF were age HR 1.039 [(1.007-1.071), p = 0.01], and GPALS ≤ 10.75% HR 28.1 [(7.2-109.1), p < 0.001]. In subjects with PnVAF and LSPnVAF with successful electrical cardioversion, GPALS ≤ 10.75% predicts arrhythmia recurrence at 6-month follow-up.
Subject(s)
Atrial Fibrillation/therapy , Atrial Function, Left , Echocardiography, Doppler, Pulsed/methods , Electric Countershock/adverse effects , Heart Atria/diagnostic imaging , Image Interpretation, Computer-Assisted/methods , Myocardial Contraction , Aged , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Biomechanical Phenomena , Female , Heart Atria/physiopathology , Humans , Male , Middle Aged , Predictive Value of Tests , Recurrence , Reproducibility of Results , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Atrial fibrillation (AF) is the most common arrhythmia in humans. The treatment can be one of the most difficult. It's true that AF itself it's a no-lethal arrhythmia but is often a cause of symptoms that can lead the patient to worsening in his quality of life thet predispose to serious conditions like thromboembolic events and heart failure. There is a general agreement in the benefit of antithrombotic therapy and the need of control of comorbid conditions, but there is not an ideal treatment for AF and the choice for the best treatment is based on the individual differences of each patient. Physician and patient must be aware of the risks and possible complications as well as the options in antiarrhythmic and antithrombotic drugs available in order to choose the best for each patient. We must get the message across that AF patients show a dynamic curse of the disease so reevaluation of the individual risk and response to therapy should be made.
Subject(s)
Atrial Fibrillation/diagnosis , Atrial Fibrillation/therapy , Humans , Practice Guidelines as TopicABSTRACT
Atrial fibrillation (AF) represents a global public health problem. The implementation of a clinical practice guideline is essential to standardize the diagnosis, treatment and prognosis of this rhythm disturbance. However, due to the wide clinical spectrum which is associated with AF, it makes difficult to standardize the recommendations and cause that are not always appropriate interpretations of the same setting, so there will be some clinical reflections of the recommendations in the clinical practice guidelines published in this journal, to assist the medical not specialist to put them in everyday clinical setting.
