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Cardiovascular Research 2000 47(2):244-253; doi:10.1016/S0008-6363(00)00100-0
© 2000 by European Society of Cardiology
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Copyright © 2000, European Society of Cardiology

Changes in atrial electrical properties following cardioversion of chronic atrial fibrillation: relation with recurrence

Emmanuel G. Manios, Emmanuel M. Kanoupakis, Gregory I. Chlouverakis, Mihail D. Kaleboubas, Hercules E. Mavrakis and Panos E. Vardas*

Department of Cardiology, University Hospital of Heraklion, P.O. Box 1352 Stavrakia, Heraklion, Crete, Greece

* Corresponding author. Tel.: +30-81-392-706; fax: +30-81-542-055 cardio{at}med.uoc.gr

Objective: To study the reversibility of atrial electrical remodeling and its relation with recurrence in post-conversion chronic atrial fibrillation (CAF) patients. Methods: In 28 drug-free CAF patients (mean AF duration 41±39 months) electrically converted to sinus rhythm effective refractory period (ERP) at 500 ms, monophasic action potential at 90% of repolarization (MAPd90) at five cycle lengths (CL, 350, 400, 450, 500, 600 ms), and P wave duration were measured three times: within the interval 5–20 min post-conversion, 24 h and 1 month later. Fifteen subjects with no history of AF and normal atrial structure served as a control group. Patients were followed up for recurrence for 1 month; 12 relapsed. Results: ERP changed from 205±20 to 243±31 to 241±24 ms (P<0.001), attaining a level comparable to that of the controls (238±21 ms) within 24 h. MAPd90 significantly (P<0.001) increased (from 175±11 to 190±19 to 191±10 ms at CL 350 ms and 201±12 to 234±20 and 233±23 ms at CL 600 ms) also reaching control levels within 24 h. MAPd90 exhibited an abnormal adaptation to rate only in the first evaluation. P wave duration was prolonged (137±33 ms) and exhibited a slower course of shortening (130±32 to 123±27 ms, P<0.001), reaching control levels within 1 month. Patients with higher values of MAPd90 at CL 350 in the immediate post-conversion period were more likely to relapse (P<0.005). Conclusions: ERP and repolarization shortening as a result of CAF are reversed within 24 h after conversion, while P wave duration reduces more slowly. Post-conversion MAPd90 values contain prognostic information for recurrence.

KEYWORDS Atrial function; Defibrillation; Remodeling; Supraventr. arrhythmia


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