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      Predictors of Atrial Fibrillation Recurrence in Hyperthyroid and Euthyroid Patients

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          Abstract

          Background

          Atrial fibrillation (AF) is the most common arrhythmia in adults, and is encountered in 10-15% of the patients with hyperthyroidism. Unless euthyroidism is restored, pharmacological or electrical cardioversion is controversial in patients with AF who remain hyperthyroid.

          Objective

          The aim of this study was to assess the efficacy of electrical cardioversion and predictors of AF recurrence in hyperthyroid and euthyroid patients.

          Methods

          The study included 33 hyperthyroid (21 males) and 48 euthyroid (17 males) patients with persistent AF. The patients were sedated with intravenous midazolam before undergoing electrical cardioversion delivered by synchronized biphasic shocks. Rates of AF recurrence were recorded.

          Results

          Mean follow-up was 23.63 ± 3.74 months in the hyperthyroid group and 22.78 ± 3.15 months in the euthyroid group (p = 0.51). AF recurred in 14 (43.8%) and 21 (44.7%) patients in each group, respectively (p = 0.93). Multivariate regression analysis in each group showed that AF duration was the only predictor of AF recurrence, with odds ratios of 1.38 (95% confidence interval [CI] = 1.05 - 1.82, p = 0.02) in the hyperthyroid group and 1.42 (95% CI = 1.05 - 1.91, p= 0.02) in the euthyroid group.

          Conclusion

          Rates of long-term AF recurrence were similar in successfully cardioverted hyperthyroid and euthyroid patients. The only predictor of AF recurrence in both groups was AF duration.

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          Most cited references69

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          A comparison of rate control and rhythm control in patients with atrial fibrillation.

          D Wyse, A Waldo, J Dimarco … (2002)
          There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended. We conducted a randomized, multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death. The primary end point was overall mortality. A total of 4060 patients (mean [+/-SD] age, 69.7+/-9.0 years) were enrolled in the study; 70.8 percent had a history of hypertension, and 38.2 percent had coronary artery disease. Of the 3311 patients with echocardiograms, the left atrium was enlarged in 64.7 percent and left ventricular function was depressed in 26.0 percent. There were 356 deaths among the patients assigned to rhythm-control therapy and 310 deaths among those assigned to rate-control therapy (mortality at five years, 23.8 percent and 21.3 percent, respectively; hazard ratio, 1.15 [95 percent confidence interval, 0.99 to 1.34]; P=0.08). More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug effects in the rhythm-control group as well. In both groups, the majority of strokes occurred after warfarin had been stopped or when the international normalized ratio was subtherapeutic. Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients. Copyright 2002 Massachusetts Medical Society
          Article 0 comments Cited 538 times – based on 0 reviews     Review now
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            Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy.

            R Gorlin, Louis Teichholz, Joseph M. Herman … (1975)
            The relation of minor and major axes of the left ventricle was determined in 100 left ventriculograms performed in the right anterior oblique projection. This relation taken over a wide range of volumes was used to derive a theoretically correct equation for determination of ventricular volume by echocardiography. The final equation was: V =[7.0/2.4 +d] (D3), where V = volume and D = the echocardiographically measured internal dimension. In 12 patients without asynergy, this equation accurately and directly calculated end-systolic and end-diastolic volumes whether the left ventricle was small or large. However, in 12 patients exhibiting left ventricular asynergy the correlation between angiographically and echocardiographically determined volumes was poor. Thus, caution is recommended in the use of time-motion echocardiography to calculate ventricular volumes in patients with coronary artery disease and possible left ventricular asynergy.
            Article 0 comments Cited 139 times – based on 0 reviews     Review now
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              Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography.

              James B Seward, Ruby Tsang, V. Barnes … (2003)
              We sought to determine if echocardiography enhances prediction of first age-related cardiovascular events. Whether echocardiographic assessment improves risk stratification for first cardiovascular events is not well known. This retrospective cohort study included randomly selected residents of Olmsted County, Minnesota, age >/=65 years, who had >/=1 transthoracic echocardiograms at the Mayo Clinic between 1990 and 1998, in sinus rhythm, without valvular or congenital heart disease, and followed through medical records for first myocardial infarction (MI), coronary revascularization, atrial fibrillation (AF), congestive heart failure (CHF), transient ischemic attack (TIA), stroke, or cardiovascular death. Patients were excluded if they had any of these events before the baseline echocardiogram. Of 1,160 patients (age 75 +/- 7 years; 746 women) followed for a mean of 3.8 +/- 2.7 years, 333 (29%) first events occurred (70 AF, 67 coronary revascularization procedures, 65 CHF, 48 MI, 38 stroke, 25 TIA, and 20 cardiovascular deaths). In a multivariate model, age (p /=32 ml/m(2) (p = 0.003), left ventricular (LV) mass/height >/=120 g/m (p = 0.014), LV systolic dysfunction (p < 0.001), and LV diastolic dysfunction (p = 0.029) were independent predictors. A risk-scoring algorithm was developed and validated for the prediction of first events. The five-year event-free survival was 90%, 74%, and 50% for low-, medium-, and high-risk groups, respectively. Echocardiography enhanced prediction of first cardiovascular events in this referral-based elderly cohort. Its role in risk stratification for primary prevention of these events in the community warrants further investigations.
              Article 0 comments Cited 71 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arq Bras Cardiol
                Journal ID (iso-abbrev): Arq. Bras. Cardiol
                Journal ID (publisher-id): abc
                Title: Arquivos Brasileiros de Cardiologia
                Publisher: Sociedade Brasileira de Cardiologia - SBC
                ISSN (Print): 0066-782X
                ISSN (Electronic): 1678-4170
                Publication date (Print and electronic): February 2016
                Publication date (Print): February 2016
                Volume: 106
                Issue: 2
                Pages: 84-91
                Affiliations
                [1 ]Edirne State Hospital - Department of Cardiology, Edirne, Turkey
                [2 ]Bursa Postgraduate Hospital - Department of Cardiology, Bursa, Turkey
                Author notes
                Mailing Address: Hasan Arı, Bursa, Yıldırım, 16320 - Turkey. E-mail: hasanari03@ 123456yahoo.com , hasanari03@ 123456hotmail.com
                Article
                DOI: 10.5935/abc.20160013
                PMC ID: 4765005
                PubMed ID: 26815460
                SO-VID: eecbc978-6693-4c38-b50d-1e93f04cb355
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 December 2014
                Date revision received : 05 April 2015
                Date accepted : 06 May 2015
                Categories
                Subject: Original Articles
                Subject: Clinical Arrhythmia

                Keywords: atrial fibrillation,recurrence,arrhythmias, cardiac,hyperthyreoidism,electric countershock
                Data availability:
                Keywords: atrial fibrillation, recurrence, arrhythmias, cardiac, hyperthyreoidism, electric countershock

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