Early recurrences of atrial fibrillation after electrical cardioversion: a result of fibrillation-induced electrical remodeling of the atria?

Department of Cardiology, Thoraxcenter, University Hospital, Groningen, The Netherlands.

OBJECTIVES: We sought to investigate whether, in humans, the timing and incidence of a relapse of atrial fibrillation (AF) during the first month after cardioversion indicates the presence of electrical remodeling and whether this could be influenced by prevention of intracellular calcium overload during AF. BACKGROUND: Animal experiments have shown that AF induces shortening of the atrial refractory period, resulting in an increased vulnerability for reinduction of AF. This electrical remodeling was completely reversible within 1 week after cardioversion of AF and was presumably related to intracellular calcium overload. METHODS: Using transtelephonic monitoring in 61 patients cardioverted for chronic AF, we evaluated the daily incidence of recurrence of AF and determined, by Cox regression analysis, the influence of patient characteristics and medication on relapse of AF. RESULTS: During 1 month of follow-up, 35 patients (57%) had a relapse of AF, with a peak incidence during the first 5 days after cardioversion. Furthermore, in patients with a recurrence of AF, there was a positive correlation between the duration of the shortest coupling interval of the premature atrial beats after cardioversion and the timing of the recurrence of AF (p = 0.0013). Multivariate analysis revealed that the use of intracellular calcium-lowering drugs during AF was the only significant variable related to maintenance of sinus rhythm after cardioversion (p = 0.03). CONCLUSIONS: The daily distribution of recurrences of AF suggests a temporary vulnerable electrophysiologic state of the atria. Use of intracellular calcium-lowering medications during AF appeared to reduce recurrences, possibly due to a reduction of electrical remodeling during AF.

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				T. H. Everett IV, H. Li, J. M. Mangrum, I. D. McRury, M. A. Mitchell, J. A. Redick, and D. E. Haines Electrical, Morphological, and Ultrastructural Remodeling and Reverse Remodeling in a Canine Model of Chronic Atrial Fibrillation Circulation, September 19, 2000; 102(12): 1454 - 1460. [Abstract] [Full Text] [PDF]

				S. Nattel and D. Li Ionic Remodeling in the Heart : Pathophysiological Significance and New Therapeutic Opportunities for Atrial Fibrillation Circ. Res., September 15, 2000; 87(6): 440 - 447. [Abstract] [Full Text] [PDF]

				E. G. Manios, E. M. Kanoupakis, G. I. Chlouverakis, M. D. Kaleboubas, H. E. Mavrakis, and P. E. Vardas Changes in atrial electrical properties following cardioversion of chronic atrial fibrillation: relation with recurrence Cardiovasc Res, August 1, 2000; 47(2): 244 - 253. [Abstract] [Full Text] [PDF]

				N.S. Peters Post-cardioversion atrial fibrillation: the synthesis of modern concepts? Eur. Heart J., July 2, 2000; 21(14): 1119 - 1121. [PDF]

				H. Nakashima, K. Kumagai, H. Urata, N. Gondo, M. Ideishi, and K. Arakawa Angiotensin II Antagonist Prevents Electrical Remodeling in Atrial Fibrillation Circulation, June 6, 2000; 101(22): 2612 - 2617. [Abstract] [Full Text] [PDF]

				R. G. Tieleman and H. J.G.M. Crijns The 'Second Factor' of tachycardia-induced atrial remodeling Cardiovasc Res, June 1, 2000; 46(3): 364 - 366. [Full Text] [PDF]

				E. R. Jessurun, N. M. van Hemel, J. C. Kelder, S. Elbers, A. B. de la Riviere, J. J.A.M. Defauw, and J. M.P.G. Ernst Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed? Eur. J. Cardiothorac. Surg., May 1, 2000; 17(5): 530 - 537. [Abstract] [Full Text] [PDF]

				E. R. Jessurun, N. M. van Hemel, J. A. M. T. Defauw, M. A. M. Stofmeel, J. C. Kelder, A. Brutel de la Riviere, and J. M. P. G. Ernst Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation Circulation, April 4, 2000; 101(13): 1559 - 1567. [Abstract] [Full Text] [PDF]

				W. J. C. Hobbs, S. Fynn, D. M. Todd, P. Wolfson, M. Galloway, and C. J. Garratt Reversal of Atrial Electrical Remodeling After Cardioversion of Persistent Atrial Fibrillation in Humans Circulation, March 14, 2000; 101(10): 1145 - 1151. [Abstract] [Full Text] [PDF]

				P. C. Viswanathan and Y. Rudy Cellular Arrhythmogenic Effects of Congenital and Acquired Long-QT Syndrome in the Heterogeneous Myocardium Circulation, March 14, 2000; 101(10): 1192 - 1198. [Abstract] [Full Text] [PDF]

				A Capucci, G.Q Villani, D Aschieri, A Rosi, and M.F Piepoli Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation Eur. Heart J., January 1, 2000; 21(1): 66 - 73. [Abstract] [PDF]

				A. A. Grace and A.J. Camm Voltage-gated calcium-channels and antiarrhythmic drug action Cardiovasc Res, January 1, 2000; 45(1): 43 - 51. [Full Text] [PDF]

				M. M. Rahme, B. Cotter, E. Leistad, M. K. Wadhwa, R. Mohabir, A. P. D. W. Ford, R. M. Eglen, and G. K. Feld Electrophysiological and Antiarrhythmic Effects of the Atrial Selective 5-HT4 Receptor Antagonist RS-100302 in Experimental Atrial Flutter and Fibrillation Circulation, November 9, 1999; 100(19): 2010 - 2017. [Abstract] [Full Text] [PDF]

				R. G. Tieleman, Y. Blaauw, I. C. Van Gelder, C. D. J. De Langen, P. J. de Kam, J. G. Grandjean, K. W. Patberg, K. J. Bel, M. A. Allessie, and H. J. G. M. Crijns Digoxin Delays Recovery From Tachycardia-Induced Electrical Remodeling of the Atria Circulation, October 26, 1999; 100(17): 1836 - 1842. [Abstract] [Full Text] [PDF]

				M. A Allessie Atrial fibrillation-induced electrical remodeling in humans: What is the next step? Cardiovasc Res, October 1, 1999; 44(1): 10 - 12. [Full Text] [PDF]

				A. De Simone, G. Stabile, D. F. Vitale, P. Turco, M. Di Stasio, F. Petrazzuoli, M. Gasparini, C. De Matteis, R. Rotunno, and T. Di Napoli Pretreatment with verapamil in patients with persistent or chronic atrial fibrillation who underwent electrical cardioversion J. Am. Coll. Cardiol., September 1, 1999; 34(3): 810 - 814. [Abstract] [Full Text] [PDF]

				E. G. Daoud, P. Marcovitz, B. P. Knight, R. Goyal, K. C. Man, S. A. Strickberger, W. F. Armstrong, and F. Morady Short-Term Effect of Atrial Fibrillation on Atrial Contractile Function in Humans Circulation, June 15, 1999; 99(23): 3024 - 3027. [Abstract] [Full Text] [PDF]

				S. Nattel Atrial electrophysiological remodeling caused by rapid atrial activation: underlying mechanisms and clinical relevance to atrial fibrillation Cardiovasc Res, May 1, 1999; 42(2): 298 - 308. [Abstract] [Full Text] [PDF]