Introduction: Currently, catheter ablation in patient with persistent atrial fibrillation is well accepted treatment. However the data on efficacy of this procedure in long-standing persistent atrial fibrillation (LSPAF) is relatively poor and inconsistent. In addition the data on efficacy of the elective external electrical cardioversion (ECV) alone in patients with LSPAF are scare and refers mainly to short term (e.g.one month) follow up. Therefore assessment of the true value of catheter ablation in rhythm control in patients with LSPAF is difficult if not impossible. The aim of the present study is to assess efficacy of elective electrical cardioversion and rhythm control in patients with LSPAF.
Methods:We enrolled 50 consecutive patients refered to our hospital (age 68 ± 9; 68% - M) with LSPAF (mean time 54 months ±48; left atrium size 4,3 cm±0.5; CHA2DS2-VASc score 3 ±2 ). All pts. underwent elective ECV and were followed for 6 month. Patient were treated with AA drugs: beta-blockers, amiodarone, propafenone, flecainide or verapamil. Rhythm was assessed during follow up visits based on the symptoms, standard and 24 h
Results:In 45 patients (90%) SR was restored after ECV. Sinus rhythm without recurrent AF reminded over 1 month in 31 pts. (69%), 3 month in 20pts (44%) and 6 month follow up in 18 pts (40%). Pts with recurrence of AF after 6 month were older (72±9 vs 65±7), had longer AF (74 vs 23month). There were no significant differences in respect of sex, left atrium size and CHA2DS2-VASC score between groups
Conclusions:Immediate efficacy of elective electrical cardioversion and rhythm control in patients with long standing, persistent atrial fibrillation is high. Results of ablation should be consider results of ECV of LPAF.