Does the Policy of Repeated Early Cardioversion for Recurrences of Atrial Fibrillation Work?

摘要

Atrial fibrillation (AF) is a very common arrhythmia, which increases in prevalence in patients more than 60 years old. Over time, it tends to become persistent or permanent, even if no underlying structural heart disease is present. The success rate of electrical cardioversion and the maintenance of sinus rhythm are highly dependent on the duration of the previous AF episode. After electrical cardioversion only 20(percent)-40(percent) of patients maintain sinus rhythm for the first year [1]. The highest incidence of recurrences is seen during the first month after cardioversion, particularly within the first 5 days, when AF recurs in up to 40(percent) of patients [2].The mechanism of early relapses seems to be different from that of late recurrences. A possible explanation for early relapses is remodeling of the atria: AF itself causes progressive electrophysiological and structural changes to the atria and modification of the autonomic innervation, which initiate or perpetuate AF [3]. Serial electrical cardioversion is often used to maintain sinus rhythm in patients with persistent AF. However, its usefulness is still debated [4, 5]. We have recently demonstrated the efficacy of a policy of serial electrical cardioversion after early AF recurrences [6].