Korean Circ J.  2023 May;53(5):331-343. 10.4070/kcj.2022.0291.

The Impact of Right Atrial Size to Predict Success of Direct Current Cardioversion in Patients With Persistent Atrial Fibrillation

Affiliations
  • 1Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
  • 2Department of Internal Medicine II, Helios Hospital Pirna, Pirna, Germany

Abstract

Background and Objectives
The prognostic implication of right atrial (RA) and left atrial (LA) size for an immediate success of direct current cardioversion (DCCV) in atrial fibrillation (AF) remains unclear. This study aimed to compare RA and LA size for the prediction of DCCV success.
Methods
Between 2012 and 2018, 734 consecutive outpatients were screened for our prospective registry. Each eligible patient received a medical history, blood analysis, and transthoracic echocardiography with a focus on indexed RA (iRA) area and LA volume (iLAV) prior to DCCV with up to three biphasic shocks (200-300-360 J) or additional administration of amiodarone or flecainide to restore sinus rhythm.
Results
We enrolled 589 patients, and DCCV was in 89% (n=523) successful. Mean age was 68 ± 10 years, and 40% (n=234) had New York heart association class >II. A prevalence of the male sex (64%, n=376) and of persistent AF (86%, n=505) was observed. Although DCCV success was associated with female sex (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.06–3.65), with absence of coronary heart disease and normal left ventricular function (OR, 2.24; 95% CI, 1.26–4.25), with short AF duration (OR, 1.93; 95% CI, 1.05–4.04) in univariable regression, only iRA area remained a stable and independent predictor of DCCV success (OR, 0.27; 95% CI, 0.12–0.69; area under the curve 0.71), but not iLAV size (OR, 1.16; 95% CI, 1.05–1.56) in multivariable analysis.
Conclusions
iRA area is superior to iLAV for the prediction of immediate DCCV success in AF.

Keyword

Atrial fibrillation; Electrical cardioversion; Transthoracic echocardiography; Right atrium

Figure

  • Figure 1 Comparison of both iRA area (A) and iLAV (B) with AF type. The dashed horizontal lines represent the cut-off values for iRA area >10.5 cm2/m2 and iLAV >37 mL/m2.AF = atrial fibrillation; DCCV = direct current cardioversion; iLAV = indexed left atrial volume; iRA = indexed right atrial; LA = left atrial; RA = right atrial.

  • Figure 2 Overall probability (P) of DCCV success as a function of RA (A) and LA size (B) derived from the full regression model in Table 1 with the 95% confidence interval (gray area). The dashed horizontal lines represent the cut-off values for iRA >10.5 cm2/m2 and iLAV >37 mL/m2.AF = atrial fibrillation; DCCV = direct current cardioversion; iLAV = indexed left atrial volume; iRA = indexed right atrial; LA = left atrial; RA = right atrial.

  • Figure 3 Overall and etiology-specific probability (P) of DCCV success as a function of age (A), LV systolic function (B), LV diastolic function (C), and RV systolic function (D).DCCV = direct current cardioversion; E/Em = ratio of peak early diastolic filling (E) to early diastolic lateral mitral annular velocity (Em) (representative of the left ventricular filling pressure, i.e., diastolic function); EF = ejection fraction; LV = left ventricular; RV = right ventricular; TAPSE = tricuspid annular plane systolic excursion.


Cited by  1 articles

Is Right Atrial Remodeling an Additional Marker for the Progression of Atrial Fibrillation?
Jin-Kyu Park
Korean Circ J. 2023;53(5):344-346.    doi: 10.4070/kcj.2023.0069.


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