Factors influencing the maintenance of sinus rhythm one year after cardioversion in patients with persistent atrial fibrillation

Abstract

Introduction . Pharmacological or electrical cardioversion is recommended for the elective restoration of sinus rhythm in patients with persistent atrial fibrillation (AF). However, predictors of long-term sinus rhythm maintenance following cardioversion are insufficiently studied. Objective . To determine the impact of clinical and echocardiographic parameters on the risk of AF recurrence after cardioversion. Materials and methods. The study included 105 patients with persistent and long-standing persistent AF who underwent successful cardioversion. Prospective follow-up was conducted for 12 months post-cardioversion to identify arrhythmia recurrence. Results . AF recurrence within 12 months after elective cardioversion was observed in 57/105 (54.3%) patients. According to multivariate regression analysis with stepwise exclusion of less significant predictors, achieving target blood pressure levels (beta -1.088, OR 0.153, 95% CI 0.048-0.490, p = 0.002) and target lipid profile parameters (beta -1.250, OR 0.286, 95% CI 0.089-0.920, p = 0.036) reduced the likelihood of AF recurrence, while an increase in left atrial volume index (beta 0.079, OR 1.082, 95% CI 1.032-1.133, p = 0.001) increased the risk of arrhythmia recurrence. The use of sodium-glucose cotransporter 2 inhibitors in patients with congestive heart failure contributed to the maintenance of sinus rhythm for 12 months after cardioversion. Conclusion . Achieving target blood pressure and lipid profile parameters before cardioversion reduces the risk of AF recurrence, whereas a significant increase in left atrial volume index promotes arrhythmia recurrence within 12 months after successful cardioversion.