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Peak Early Diastolic Transmitral Velocity As A Surrogate Marker Of Short-Term Atrial Fibrillation Recurrence After Electrical Cardioversion

Objectives: The aim of this study was to investigate the significance of peak early diastolic transmitral velocity (E-wave) and N-terminal pro Brain Natriuretic Peptide (NT-pro BNP) on short-term atrial fibrillation (AF) recurrence.

Methods: We prospectively studied 57 consecutive patients who underwent electrical cardioversion (CV) for AF and successfully converted to sinus rhythm. All patients underwent transthoracic echocardiography (TTE) and we measured BNP before and after CV. The follow-up included physical examination, a 12-lead electrocardiogram and a TTE 14 days and one month after the CV.

Results: In 42.1% patients AF recurred. Gender, presence of mitral regurgitation, treatment with angiotensin II receptor blocker and left atrium diameter influenced independently E-wave levels before CV. E-wave fell immediately after successful CV (94.0±27 cm/s vs 79.7±23 cm/s, P<0.0001). E-wave before CV>94 cm/s and E-wave after CV >80 cm/s were predictors of one-month AF recurrence [(Hazard Ratio) HR=3.624 with 95% CI=1.496-8.783 and HR=3.767 with 95% CI=1.404-10.107, respectively]. E-wave before and E-wave after CV remained strong predictors of AF recurrence but only in non-hypertensive patients (HR=1.018 with 95% C.I=1.001-1.035 and HR=1.033 with 95% C.I=1.004-1.062, respectively). Similarly, NT-pro BNP levels before and after CV increased the risk of AF recurrence   (HR=1.14 with 95% C.I 1.01-1.28 and HR= 1.16 with 95% C.I 1.03- 1.31, respectively). NT-proBNP levels added on E-wave before CV had incremental value on short-term AF recurrence at a marginally statistical significance (LR chi2=3.28, p=0.07).

Conclusions: E-wave and BNP had prognostic significance on short-term recurrence of AF after CV.

Credits: Christos Varounis; Themistoklis Maounis; Dennis V Cokkinos

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