持续性房颤电复律后射频消融术中成功率及术后短期复发率的研究

【】目的 通过研究持续性房颤经电复律成功后再行射频消融术治疗与直接行射频消融术治疗的术中直接复律效果,探索更适宜接受射频消融术治疗的持续性房颤人群特点。方法 回顾分析2011年9月------2014年1月在我院行房颤射频消融术的54例持续性房颤患者,根据术前是否经同经步直流电复律为窦性心律,且维持窦性心律维持超过3个月,分为2组。A组术前经同经步直流电复律为窦性心律并维持窦性心律维持超过3个月后再发房颤,再接受射频消融术治疗16例,B组未行电复律,直接射频消融术治疗38例,比较2组术中射频消融直接恢复窦性心律比率及术后6个月房颤复发率。结果 术中直接复律率A组高于B组(56.2% VS 26.3% p =0.035)6个月复发率A组低于B组(18.8％ VS 47.3％, p =0.045)。结论 经电复律后可较长时间维持窦性心律的持续性房颤患者接受射频消融术治疗复律成功率较高,早期复发率低。     

心房颤动发病相关因素的临床研究

目的探讨幽门螺杆菌(Helicobacter pylori,Hp)感染、高敏-CRP(High sensitivity C-reactiveprotein,Hs-CRP)水平、左心房内径(Lef tatriumdiameter,LAD)与房颤的相关性。方法回顾性分析2007年1月至2012年12月在我院住院治疗的房颤患者262例,非房颤患者115例;所有病例均行13C呼气试验测定、血浆幽门螺杆菌抗体(HpIgG)测定、Hs-CRP水平测定及超声心动检查。结果①心房颤动组13C呼气试验幽门螺杆菌、hs-CRP、左心房内径阳性率明显高于非心房颤动组(p<0.05);②心房颤动组13C呼气试验幽门螺杆菌感染δ值、hs-CRP以及左心房内径水平明显高于非心房颤动组(p<0.05);③首发房颤、阵发性房颤、持续性房颤、长程持续性房颤以及永久性房颤5个亚组分别两两比较:永久性房颤组Hpδ值高于初发房颤组、阵发性房颤组及持续性房颤组(p<0.05);永久性房颤组hs-CRP水平高于首发房颤组、阵发性房颤组及持续性房颤组(p<0.05);长程持续性房颤组hs-CRP水平高于首发房颤组、阵发性房颤组(p<0.05);永久性房颤组左心房内径水平高于首发房颤组、阵发性、持续性房颤组(p<0.05);④综合HP感染、hs-CRP、左心房内径及其他危险因素后,发现Hp≥4‰、hs-CRP>5mg/L以及左心房内径≥36mm与心房颤动较强的相关性(p<0.05)。结论 HP感染、hs-CRP升高、左心房内径增大均可反应房颤的发生率;Hp≥4‰、hs-CRP>5mg/L、左心房内径≥36mm均是患者心房颤动的敏感指标。     

炎症与非瓣膜性心房颤动患者左心耳血栓相关性研究

目的探讨炎症与非瓣膜心房颤动(简称房颤)患者左心耳血栓之间的相关性。方法共入选经食管心脏超声检查患者68例,其中左心耳血栓者(血栓组)23例,无左心耳血栓者(对照组)45例。所有患者测量血高敏C反应蛋白(hs-CRP)水平。结果血栓组hs-CRP水平(1.66mg/L,0.49～2.60mg/L)明显高于对照组(0.83mg/L,0.47～1.32mg/L),在校正了CHA2DS2-VASc评分、左房大小、房颤类型等因素后,hs-CRP水平增高仍然是左心耳血栓形成的危险因素(OR=1.19,95%可信区间1.02～1.39,P=0.02)。结论炎症在非瓣膜房颤左心耳血栓的形成过程中发挥了一定的作用。     

心房颤动电复律的相关因素

目的分析影响心房颤动电复律成功的因素。方法根据房颤患者62例电复律是否成功,分为复律成功组和失败组。比较两组在性别、年龄、并发冠心病、高血压病和瓣膜性心脏病、左心房内径、左心室舒张末期内径、左心室射血分数、C反应蛋白（CRP）水平的差异。CRP检测:所有患者于入院后/入组后第2天常规空腹抽血,采用免疫比浊法测定高敏感CRP（hs-CRP）。结果与转复成功组比较,转复失败组年龄大（P<0.05）,左心房内径大（P<0.05）,并发瓣膜性病变比例高（P<0.05）,房颤持续时间长（P<0.05）,hs-CRP水平高（P<0.05）。经多因素分析,hs-CRP水平OR为2.1（95%CI1.4-3.2,P<0.01）、左房直径OR为1.8（95%CI1.2-2.2,P<0.01）和房颤持续时间OR为2.8（95%CI1.6-4.0,P<0.01）。结论hs-CRP、左房直径及房颤持续时间是影响房颤电复律成功的独立预测因素。     

伊布利特在转复导管消融术后持续性心房颤动中的应用以及对术后心房颤动复发的预测

目的:观察伊布利特在转复导管消融术后持续性心房颤动(房颤)的有效性及安全性,以及复律成功与否对导管消融术后房颤复发的预测。方法:入选2014-08-2016-08在郑州大学人民医院接收导管射频消融术但术后未能转复窦性心律(窦律)的持续性房颤患者248例,其中男146例,女102例;平均年龄(63.9±7.2)岁。术中静脉推注伊布利特1 mg,若仍未转复,则再次给予1 mg。若仍未恢复窦律,则根据情况给予超速抑制或电复律。依据"2C3L"术式导管消融+伊布利特应用后是否恢复窦律将患者分为有效组和无效组。比较2组患者的临床资料的差异,观察伊布利特在转复导管消融术后持续性房颤中的有效性及安全性;随访24个月,观察2组患者房颤的早期及晚期复发率。统计复律成功与否对导管消融术后房颤复发的预测效果。结果:伊布利特转复导管消融术后持续性房颤的总成功率为72.1%,无严重不良事件发生。2组患者在房颤持续时间、左房内径、射血分数值、BNP水平均差异有统计学意义;在年龄、性别、合并疾病(高血压病、糖尿病、冠心病)等差异均无统计学意义。经"2C3L"术式导管消融+伊布利特应用后恢复窦律者的房颤早期复发及晚期复发率均较未恢复窦律者低。结论:伊布利特转复导管消融术后持续性房颤的成功率高、安全性良好,且伊布利特复律成功预示房颤导管消融术后早期、晚期复发均较低。     

尼非卡兰在心房颤动射频消融中的初步运用

目的观察心房颤动(简称房颤)消融术中环使用尼非卡兰复律的有效性及安全性。方法行导管消融治疗的房颤患者41例,术中行环肺静脉电隔离(CPVI)后心律仍为房颤,经静脉给予尼非卡兰注射液(50 mg)(负荷量0.3 mg/Kg 5 min,后予维持剂量(0.4 mg·Kg~(-1)·h~(-1))转复。术后予心电监护2 h。以60例同期行CPVI术但心律为房颤而行电复律患者作为对照组,比较两组即刻转复成功率,不良反应发生率,术后1、3个月超过30 s房性心律失常发生率。结果尼非卡兰组31例转复为窦性心律(简称窦律),3例转为心房扑动,进一步消融后转复为窦律,另3例患者仍为房颤,行电复律后转为窦律。电复律组1例3次电复律后仍不能维持窦律。尼非卡兰组即刻复律成功率低于电复律组(31/41 vs 59/60,P<0.05)。尼非卡兰组1例出现心室颤动,电复律组3例出现嗜睡、6例出现呕吐、1例出现低血压。术后7天内及1个月内超过30 s房性心律失常发生情况,尼非卡兰组为9/41,12/41;18/60,22/60,P>0.05。结论观察初步表明房颤消融CPVI后使用尼非卡兰复律具有较高的成功率,其不良反应发生率较低。     

持续性心房颤动电复律术后近期复发的影响因素

目的探讨持续性心房颤动(简称房颤)电复律术后近期复发的预测因素,并初步探讨其临床意义。方法62例行电复律的持续性房颤患者,分析患者的年龄、性别、病史、左房大小、P波终末电势(PtfV1)、二尖瓣狭窄程度、左室射血分数、左房射血力、VE/VA、合并高血压与电转复术后2个月内复发的关系。结果62例电复律后2个月内复发22例,复发率35.5%,单因素分析示电转复后左房扩大、二尖瓣狭窄、PtfV1异常与房颤近期复发显著相关,多因素逻辑回归分析结果只有左房扩大是电转复术后持续性房颤复发的独立危险因素。结论左房扩大是持续性房颤电复律术后复发的独立危险因素,二尖瓣狭窄及PtfV1异常使持续性房颤电复律术后的近期复发率增高。     

非瓣膜性心房颤动患者C反应蛋白与左心房自发显影的关系

目的探讨高敏C反应蛋白(hs-CRP)与非瓣膜性心房颤动(房颤)患者左心房自发显影(LASEC)的关系。方法连续入选自2018年1月1日至6月30日于首都医科大学附属北京安贞医院心内科病房首次行射频消融术的非瓣膜性房颤患者490例,根据术前经食管超声心动图检查结果将研究人群分为无LASEC组(n=338)和LASEC组(n=152)。采用胶乳增强免疫比浊法测定hs-CRP;用单因素及多因素logistic分析探讨非瓣膜性房颤患者hs-CRP与LASEC的相关性。结果490例患者中有152例(31%)检测到LASEC。LASEC组的年龄、房颤类型、既往栓塞事件、纤维蛋白原定量、D-二聚体、左心房前后径及CHA2DS2VASc评分与无LASEC组比较,差异均有统计学意义(P均<0.05),LASEC组hs-CRP水平明显高于无LASEC组[3.16(1.30,5.23)mg/L比0.67(0.37,1.48)mg/L,P<0.001]。多因素logistic回归分析发现hs-CRP(OR=1.136,95%CI 1.060~1.217,P<0.001)和D-二聚体(OR=1.040,95%CI 1.011~1.070,P=0.007)是LASEC的独立相关因素。结论hs-CRP升高是非瓣膜性房颤患者LASEC的独立相关因素,炎症反应可能参与非瓣膜性房颤血栓前状态的形成。     

单纯疱疹病毒感染与心房颤动的相关性研究

目的观察单纯疱疹病毒(HSV)感染与心房颤动(房颤)的相关性。方法严格筛选103例孤立性房颤患者,分为阵发性房颤组74例和持续性房颤组29例,从流行病学对照研究队列中选取72例未合并房颤的健康人群作为对照组。空腹采集静脉血,用ELISA法按试剂盒标准流程检测血清HSV1 IgG抗体、HSV2 IgG抗体水平;运用相关分析探讨患者血清高敏C反应蛋白(hs-CRP)水平与HSV1 IgG抗体、HSV2 IgG抗体滴度的关系。结果对照组、阵发性房颤组和持续性房颤组的血清HSV1 IgG抗体水平分别为(217.95±53.18)μg/ml、(304.76±57.58)μg/ml和(322.99±60.35)μg/ml,血清HSV2 IgG抗体水平分别为(307.25±64.02)μg/ml、(407.22±59.1)μg/ml和(406.63±50.67)μg/ml,hs-CRP水平分别为(2.16±0.70)mg/L、(3.90±0.59)mg/L和(3.90±0.63)mg/L;对照组的血清HSV1 IgG抗体、HSV2 IgG抗体、hs-CRP水平均显著低于阵发性房颤组和持续性房颤组(均P0.001);阵发性房颤组与持续性房颤组的血清HSV1 IgG抗体、HSV2 IgG抗体、hs-CRP水平比较,差异均无统计学意义(均P0.05)。血清HSV IgG抗体水平与hs-CRP水平呈正相关关系(rHSV1=0.532,P0.001;r_(HSV2)=0.446,P0.001)。结论房颤患者的血清HSV IgG抗体水平显著升高,且与血清hs-CRP水平呈正相关。     

H型高血压不同血压水平对脑卒中的预防价值

目的:探讨H型高血压患者脑卒中疗效更好的目标血压。方法:600例H型高血压患者,根据血压水平被分为低水平组(120/90mmHg或DBP90mmHg,200例)、中等水平组(120～130/90mmHg或DBP90mmHg,200例)和高水平组(130～140/90mmHg或DBP90mmHg,200例),三组均治疗2年。治疗前,后定期测量、比较三组的血压、血清同型半胱氨酸(Hcy)、颈动脉内膜中层厚度(CIMT),随访期间记录各组不良反应率。结果:随访期间,随时间推移,三组的血清Hcy、CIMT均逐渐显著降低,P0.05或0.01。随访4周后,与低水平组比较,中等水平、高水平组SBP、DBP、Hcy水平均显著升高,高水平组SBP显著高于中等水平组,高水平组CIMT显著高于其余两组,P均=0.001;随访8周及2年后,与低水平组比较,中等水平、高水平组SBP、DBP、Hcy水平、CIMT均显著升高,高水平组SBP、CIMT显著高于中等水平组,2年后中等水平组Hcy水平显著高于高水平组,P0.05或0.01。随访2年后,高水平组的脑卒中再发率、心血管疾病和不良反应发生率均显著高于低水平组和中等水平组,中等水平组的脑卒中再发率显著高于低水平组,P0.05或0.01。结论:低水平组总体疗效显著优于中等水平组和高水平组,其降低Hcy水平的效果更显著,同时可进一步降低脑卒中的再发率及死亡率,更全面地控制心血管病的危险因素。     

Relationship between C-reactive protein level and early recurrence of atrial fibrillation after electrical cardioversion

INTRODUCTION AND OBJECTIVES: Atrial remodeling is responsible for the early recurrence of atrial fibrillation (AF) after cardioversion. Recently, it has been shown that the C-reactive protein (CRP) level is elevated in patients with AF, indicating that inflammation may play a role in the pathogenesis of this arrhythmia. We postulated that a high CRP level would predict early recurrence of AF after electrical cardioversion. PATIENTS AND METHOD: Forty-two patients with persistent AF, but without known heart disease, who underwent elective electrical cardioversion were investigated. The CRP level was measured immediately before cardioversion. The study population comprised the 37 patients in whom sinus rhythm was restored. RESULTS: After a follow-up period of 30 days, 16 patients (43%) had recurrence of AF; the other 21 (57%) remained in sinus rhythm. The mean CRP level was significantly higher in patients with AF recurrence (6.3 [3.3] mg/L vs 2.4 [2.1] mg/L, P=.0001). On dividing patients according to whether their CRP level was < or =3 mg/L or >3 mg/L, it was observed that only 33% of those in sinus rhythm had a level >3 mg/L compared with 81% of those with AF recurrence (P=.004). Patients with a CRP level >3 mg/L had a significant increase in the 1-month risk of AF recurrence (RR=3.7; 95% CI, 1.3-10.8). There was no association between CRP level and left atrial diameter (P =.50) or AF duration (P=.458). CONCLUSIONS: A high CRP level is associated with early recurrence of AF after electrical cardioversion, suggesting that inflammation could play a role in atrial remodeling.     

Relation of C-reactive protein to long-term risk of recurrence of atrial fibrillation after electrical cardioversion

The aim of this study is to assess the role of C-reactive protein (CRP) in predicting long-term risk of atrial fibrillation (AF) recurrence after electrical cardioversion. CRP levels are associated with the presence of AF and failure of electrical or pharmacologic cardioversion, but no previous study has assessed their predictive role in long-term follow-up after successful electrical cardioversion. One hundred two consecutive patients (age 67 +/- 11 years; 58 men) with nonvalvular persistent AF who underwent successful biphasic electrical cardioversion were studied. High-sensitivity CRP was measured immediately before cardioversion. Follow-up was performed up to 1 year in all cases. Patients were divided into 4 groups according to CRP quartiles. Patients in the lowest CRP quartile (<1.9 mg/L) had significantly lower rates of AF recurrence (4% vs 33% at 3 months in the other 3 groups combined, p = 0.007, and 28% vs 60% at 1 year, p = 0.01). The 4 groups were similar in age, gender, ejection fraction, and left atrial size. Survival analysis confirmed that patients in the lowest CRP quartile had a lower recurrence rate (p = 0.02). Cox regression analyses using age, gender, hypertension, diabetes, ejection fraction, left atrial diameter, use of antiarrhythmic drugs, angiotensin-converting enzyme inhibitors or angiotensin II antagonists, and statins, and CRP quartiles as covariates showed that only CRP was independently associated with AF recurrence during follow-up (hazard ratio 4.98, 95% confidence interval 1.75 to 14.26, p = 0.003). In conclusion, low CRP is associated with long-term maintenance of sinus rhythm after cardioversion for nonvalvular AF.     

High-sensitivity C-reactive protein is predictive of successful cardioversion for atrial fibrillation and maintenance of sinus rhythm after conversion

BACKGROUNDS: Cardioversion for atrial fibrillation (AF) is the most effective treatment for the restoration of sinus rhythm (SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein (hs-CRP) was predictive of the outcome of cardioversion for AF. METHODS AND RESULTS: One hundred and six patients with a history of symptomatic AF lasting > or =1 day (age 63+/-14 years, mean+/-S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients (79%). By using selected cutoff values, multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF (AF duration< or =36 days, odds ratio (OR), 0.98; 95% confidence interval (CI), 0.97-0.99), smaller left atrial diameter (left atrial diameter< or =40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction (left ventricular ejection fraction> or =60%, OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level (hs-CRP< or =0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140+/-144 days, AF recurred in 64 patients (76%). By using a cutoff value of hs-CRP> or =0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence (OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4%, respectively (log-rank test, p<0.0001). CONCLUSIONS: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.     

Time to recover from atrial hormonal, mechanical, and electrical dysfunction after successful electrical cardioversion of persistent atrial fibrillation

Although transient atrial dysfunction has been reported after electrical cardioversion of atrial fibrillation (AF), the difference in the time to recover from the atrial hormonal, mechanical, and electrical dysfunction has not been described. Thus, we evaluated the time course of recovery from atrial hormonal, mechanical, and electrical dysfunction after cardioversion in patients with nonvalvular AF. We attempted electrical cardioversion in 87 consecutive patients with nonvalvular AF that had persisted for ≥6 months, and in 24 patients (28%) with maintained sinus rhythm for ≥6 months. To evaluate atrial hormonal, mechanical, and electrical dysfunction in these 24 patients, we measured plasma concentration of atrial natriuretic peptide, the atrial peak velocity in transmitral flow, and the ratio of peak systolic-to-diastolic pulmonary venous flow (S/D ratio) using echocardiography, and the duration and the root mean voltage for the terminal 20 ms (LP20) of the filtered P wave using P-wave signal-averaged electrocardiography. Atrial natriuretic peptide rapidly returned to baseline within 1 day after cardioversion, and maintained these levels for 6 months. Atrial peak velocity in transmitral flow and S/D ratio were significantly increased at 2 weeks, and continued to increase until 1 month, and then reached a plateau. The duration and LP20 began to recover only 6 months after cardioversion. One to 3 years after conversion, the duration and LP20 had nearly reached a plateau, but the latter value remained below normal. In patients with nonvalvular AF of prolonged duration, recovery from atrial electrical dysfunction after sinus conversion took much longer than that from either atrial hormonal or mechanical dysfunction.     

预防心房纤维化对心房颤动患者射频导管消融术后复发的影响

目的探讨心房纤维化的药物预防对心房颤动(房颤)患者射频导管消融术后复发的影响。方法选取2017年6月—2018年3月于武汉大学人民医院行首次射频导管消融术的非瓣膜性房颤患者112例。收集患者临床资料并进行随访,记录患者术后预防心房纤维化的药物类型和剂量,根据随访1年的结果将患者分为术后复发组(n=19)和未复发组(n=83)。比较两组患者一般资料、实验室检查和服用药物的差异,采用SPSS 22数据分析判断心房纤维化的药物预防对房颤患者射频导管消融术后复发的影响。结果房颤患者消融术后复发组与未复发组的性别、年龄、房颤类型、高血压、糖尿病、冠心病等疾病、hs-CRP、e GFR、SCr、UA的差异无统计学意义(P> 0. 05),复发组的房颤初发年龄、房颤病史及NT-pro BNP水平明显高于未复发组(P <0. 05)。药物预防心房纤维化可减少房颤患者射频导管消融术后的1年复发率(P=0. 015),较长的房颤病史是房颤术后复发的独立危险因素。结论房颤患者射频导管消融术后复发率与房颤初发年龄、房颤病史和NT-proBNP水平相关,药物预防心房纤维化可降低房颤患者射频导管消融术...     

Recurrence of atrial fibrillation after internal cardioversion of persistent atrial fibrillation: prognostic importance of electrophysiologic parameters.

BACKGROUND: The purpose of this study was to determine whether the extent of atrial electrical remodeling affects the recurrence of atrial fibrillation (AF) after cardioversion of persistent AF (PAF). METHODS AND RESULTS: Internal atrial cardioversion was performed in 47 patients with PAF. The right atrial monophasic action potential duration (RA-MAPD) at pacing cycle lengths (PCLs) of 800-300 ms and P wave signal-averaged electrocardiogram were recorded after cardioversion. Bepridil (150-200 mg/day) and carvedilol (10 mg/day) were administered to all patients after cardioversion. Of the 47 patients, 20 had recurrent AF within 3 months. No relation was observed between age, left atrial dimension, left ventricular ejection fraction, and AF recurrence. The AF duration was significantly longer (p<0.05) and RA-MAPD at PCLs of 800 to 300 ms were significantly shorter (p<0.05) in patients with AF recurrence than in those without recurrence. The mean slope of the RA-MAPD for PCLs between 600 and 300 ms did not differ between the patients with and without AF recurrence. The filtered P-wave duration (FPD) was significantly longer in the patients with AF recurrence than in those without (p<0.05). Multivariate analysis also showed that the RA-MAPD at a PCL of 300 ms and FPD were predictors of AF recurrence (RAMAPD: p=0.038; FPD: p=0.052). CONCLUSION: These results suggest that electrical remodeling related to the repolarization and depolarization may be the main contributors to early AF recurrence after cardioversion under the administration of bepridil and carvedilol.     

脑钠肽对老年人心房颤动复律和复发的评价作用

目的 通过测定老年人窦性心律（窦律）患者和心房颤动（房颤）患者复律前后的血清脑钠肽（BNP）浓度，探讨其对老年房颤患者的评价作用及在房颤复律前后中的应用价值。方法 选择心功能正常的老年患者102例，其中阵发性房颤28例，持续性房颤40例，窦律34例，采用放射免疫方法测定窦律患者血清BNP浓度，同时对房颤患者进行复律，测定复律前、复律后24h及30d的血清BNP浓度。结果 老年房颤患者的血清BNP浓度显著高于窦律患者，并在复律后显著降低，差异有统计学意义。窦律维持组的血清BNP浓度低于房颤复发组[（238．24±97．45）pg／ml vs（323．24±62．78）pg／ml，P〈0．05]。单因素分析显示年龄、左心房内径、房颤持续时间及BNP浓度与房颤的复发有关，多因素回归分析显示BNP浓度和年龄是复律后房颤复发的独立影响因子。结论 BNP的检测可能对老年人房颤的诊断和评估、预测复律的疗效及房颤的复发具有重要的临床价值。     

Usefulness of left ventricular diastolic dysfunction assessed by pulsed tissue Doppler imaging as a predictor of atrial fibrillation recurrence after successful electrical cardioversion

The impact of left ventricular (LV) diastolic dysfunction on risk of atrial fibrillation (AF) recurrence is still unknown. The aim of this study was to assess the role of LV diastolic dysfunction in predicting AF recurrence after successful electrical cardioversion in patients with nonvalvular AF. In 51 patients with a first episode of nonvalvular AF undergoing successful electrical cardioversion, tissue Doppler echocardiography was performed to measure peak early diastolic mitral annulus velocity (E(m)) and the ratio of mitral inflow to mitral annulus velocity at end-diastole (E/E(m)). Clinical end points were recurrent persistent AF at 2-week follow-up (early AF recurrence [ERAF]) and at 1-year follow-up (including ERAF and late AF recurrence). Seventeen patients showed evidence of ERAF, whereas late AF recurrence occurred in another 5 patients. In time-independent analysis E/E(m) (odds ratio [OR] 1.746, p = 0.0084) and indexed LV end-systolic volume (OR 1.083, p = 0.040) were independent predictors of ERAF. Based on a logistic model risk of ERAF was 25% for an E/E(m) of 5.6 but increased to 50% for an E/E(m) of 8.1 and to 75% for an E/E(m) of 10.5. In time-dependent analysis E/E(m) emerged as the only predictor of ERAF (OR 1.757, p = 0.0078). E/E(m) also independently predicted risk of recurrence at 1 year in time-independent (OR 1.757, p = 0.0078) and time-dependent (OR 1.319, p = 0.0003) analyses. In conclusion LV diastolic dysfunction independently predicts AF recurrence in patients with nonvalvular AF undergoing successful electrical cardioversion.     

Effect of candesartan and various inflammatory markers on maintenance of sinus rhythm after electrical cardioversion for atrial fibrillation

Inflammatory markers, their relation to maintenance of sinus rhythm after electrical cardioversion for atrial fibrillation (AF), and the effect of candesartan were investigated in a double-blind placebo-controlled study (CAPRAF). One hundred seventy-one patients with persistent AF were randomly assigned to receive candesartan 8 mg/day or placebo for 3 to 6 weeks before and candesartan 16 mg/day or placebo for 6 months after electrical cardioversion. Serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha, interleukin-6, P-selectin, E-selectin, CD-40 ligand, and vascular cell adhesion molecule-1 were measured at baseline and end of study. Compared with patients with a relapse of AF, patients still in sinus rhythm at 6 months after cardioversion (n = 40) had lower baseline hs-CRP and E-selectin levels: median 2.36 mg/L (25th, 75th percentiles 1.28, 4.09) versus 3.44 mg/L (25th, 75th percentiles 1.66, 6.05, p = 0.031) and 32 ng/ml (25th, 75th percentiles 23, 42) versus 37 ng/ml (25th, 75th percentiles 28, 51, p = 0.042), respectively. Neither sustained sinus rhythm for 6 months nor treatment with candesartan had an impact on measured concentrations of markers of inflammation. In conclusion, low hs-CRP and E-selectin at baseline were associated with maintenance of sinus rhythm after electrical cardioversion.