| 김숙경, 박희남, 박재형, 고경정, 장진근, 박재석, 김용현, 곽재진, 이지혜, 최종일, 임홍의, 김영훈 |
Background Although the electrical cardioversion (CV) is known to be effective in restoring sinus rhythm in patients with persistent atrial fibrillation (PeAF), AF frequently recurred in spite of concomitant medication of antiarrhythmic drugs (AAD). We investigated whether the patients with certain clinical and electrophysiological parameters, or serological markers are more vulnerable to the recurrences of AF after CV.
Methods and Results 54 patients (M:F=40:14, 58±12 years old) with PeAF, who underwent CV were included and divided according to their recurrence patterns: no recurrence (NR), early recurrence within 2 weeks (ERAF), and late recurrence after 2 weeks (LRAF). Clinical and electrophysiologic parameters during CV (energy requirement, immediate recurrence of AF (IRAF), atrial premature beats) and serologic markers related matrix remodeling, fibrosis, and chemotaxis were compared. Results: 1. During 4.7±1.3 months of follow up, 25.9% (14/54) patients showed failed responses to CV or ERAF, 31.5% (17/54) patients developed LRAF, and 42.6% (23/54) patients remained in NR. 2. The patients with recurrence were older (60.5±9.5 vs. 55.2±13.3 years old, p<0.05) and showed a spontaneous echo contrast (SEC; 70.0% vs. 45.5%, p<0.05) or IRAF (16.1% vs. 0%, p<0.05) more often than those in NR group. 2. The patients with ERAF or a failed response to CV showed a higher level of stromal cell derived factor (SDF)1-α (4.37±0.72 ng/mL vs. 4.01±0.69 ng/mL, p=0.05), and more frequently taking beta-blocker (50% vs. 25%, p<0.05) or statin (28.6% vs. 5%, p<0.01) than those with NR or LRAF. 3. SEC was more commonly observed in LRAF group (82.4%) than ERAF group (53.8%, p<0.05). The patients with SEC showed a significantly higher level of pro-atrial natriuretic peptide (ANP) (8.10±3.80 ng/mL vs. 6.19±3.89 ng/mL, p<0.05) and developed recurrence after longer period of maintenance in sinus rhythm (17.2±22.9 days vs. 6.7±10.6 days, p<0.05).
Conclusion Post-CV recurrence commonly occurred in patients with old age > 60, SEC, and IRAF. SDF1-α may predict failed CV or ERAF, and the patients with SEC and high pro-ANP frequently recurred after 2 weeks of CV.
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