Hassan Kamal, Aysha Siddiqa, Azmat Hayat, Maham Zahid, Ahmad Jalal, Qurban Hussain Khan, Nimra Faryal, Khwaja Ehtasham Ahmad, Hafsa Inam.
Success of elective cardioversion in persistent atrial fibrillation patients with or without diastolic dysfunction as assessed by left atrial volume index.
Pak Armed Forces Med J Jan ;69(Suppl1):S141-47.

Objective: To compare the success of elective electro-cardioversion of persistent AF patients presented with or without diastolic dysfunction as assessed by left atrial volume index (LAVI); and to compare the relationship between recurrence of AF after elective electro-cardioversion and LAVI. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from Jan to Aug 2018. Material and Methods: Patients belonging to age group of 40 - 80 years, either gender, presenting with newly diagnosed non-valvular, persistent AF were prospectively enrolled in the study. Patients failed to achieve normal sinus rhythm after chemical cardio version of 3 weeks were identified to be candidates for electro-cardio version. Successful patients were followed up for six months to find out any recurrences by assessing their rhythm via electro cardiogram and physical/clinical examination. Results: Elective electro-cardioversion was performed for 50 patients, with mean age of 58.1 +- 8.7 years (age range 42-75), 34 (68.0%) males and 16 (32.0%) females. Forty One (82.0%) patients achieved normal sinus rhythm following cardioversion. Univariate analysis of immediate success of cardioversion and LAVI showed that patients with LAVI of <30 ml/m2 are 1.4 times more likely to achieve normal sinus rhythm immediately after electro-cardioversion (OR=1.43, 95% CI=1.1-2.0, p-value 0.015). At the end of 6 months follow up, a total of 63.4% (n=26) patients had experienced recurrence of AF after electro-cardioversion. Conclusion: Our study supports the fact that diastolic dysfunction assessed by LAVI is a significant predictor of immediate success of elective cardioversion in persistent AF patients, as well as recurrence of AF after successful cardioversion.

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