Reversal of Electrical Remodeling After Cardioversion of Persistent Atrial Fibrillation
Abstract
Introduction: In animals, atrial fibrillation results in reversible atrial electrical remodeling manifested as shortening of the atrial effective refractory period, slowing of intra‐atrial conduction, and prolongation of sinus node recovery time. There is limited information on changes in these parameters after cardioversion in patients with persistent atrial fibrillation. Methods and Results: Thirty‐eight patients who had been in atrial fibrillation for 1 to 12 months underwent electrophysiologic testing 10 minutes and 1 hour after cardioversion. At 1 week, 19 patients still in sinus rhythm returned for repeat testing. Reverse remodeling of the effective refractory period was not uniform across the three atrial sites tested. At the lateral right atrium, there was a highly significant increase in the effective refractory period between 10 minutes and 1 hour after cardioversion (drive cycle length 400 ms: 204 ± 17 ms vs 211 ± 20 ms, drive cycle length 550 ms: 213 ± 18 ms vs 219 ± 23 ms, P < 0.001). The effective refractory period at the coronary sinus and distal coronary sinus did not change in the first hour but had increased by 1 week. The corrected sinus node recovery time did not change in the first hour but was shorter at 1 week (606 ± 311 ms vs 408 ± 160 ms, P = 0.009). P wave duration also was shorter at 1 week (135 ± 18 ms vs 129 ± 13 ms, P = 0.04) consistent with increasing atrial conduction velocity. Conclusion: The atrial effective refractory period increases, sinus node function improves, and atrial conduction velocity goes up in the first week after cardioversion of long‐standing atrial fibrillation in humans. Reverse electrical remodeling of the effective refractory period occurs at different rates in different regions of the atrium. (J Cardiovasc Electrophysiol, Vol. 15, pp. 507‐512, May 2004)
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Female sex is a well-recognized, independent risk factor for AF-related stroke and systemic thromboembolism.
“Female sex is a well-recognized, independent risk factor for AF-related stroke13 and systemic thromboemblism.63–65”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [64]
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- Authors
- RAITT, M. H., KUSUMOTO, W., GIRAUD, G., & MCANULTY, J. H.
- Affiliations
- Oregon Health & Science University (US)
- Exempla Saint Joseph Hospital (US)
- Portland VA Medical Center (US)
- Corresponding author
- RAITT, MERRITT H.
- ORCID
- RAITT, MERRITT H.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2004-04-30
- Volume
- 15
- Issue
- 5
- Pages
- 507-512
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2066155196
- Cited by
- 87
- References
- 27
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 9 · 2016: 3 · 2015: 2 · 2014: 2 · 2013: 5 · 2012: 11
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- persistent atrial fibrillation, cardioversion, atrial electrical remodeling, reverse remodeling, atrial effective refractory period, sinus node recovery time, atrial conduction velocity, P-wave duration, coronary sinus, right atrium
- MeSH terms
- Adaptation, Physiological, Aged, Atrial Fibrillation, Chronic Disease, Electric Countershock, Female, Heart Atria, Heart Conduction System, Humans, Male, Middle Aged, Refractory Period, Electrophysiological, Treatment Outcome, Recovery of Function, Ventricular Remodeling
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