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Spontaneous conversion is most likely to occur in patients with first-onset, short-duration episodes of atrial fibrillation (<24 h), lower body mass index, and normal left atrial size.
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The results of the current study facilitate the identification of patients with a high likelihood of spontaneous conversion to sinus rhythm and the implementation of a wait-and-see approach.
Introduction
Methods
Setting
Study population
Data collection
Definitions
Statistical analysis
Results
Total, n = 943 | Non-SCV n = 785 (83.2%) | SCV n = 158 (16.8%) | p-value (non-SCV vs SCV) | ||
---|---|---|---|---|---|
Demographics | |||||
Age, years (±SD) | 68.5 | (±12.6) | 69.7 | (±11.3) | 0.257 |
Female, n (%) | 361 | (46.0%) | 85 | (53.8%) | 0.073 |
BMI, kg/m2 (±SD) | 28.5 | (±6.5) | 27.0 | (±4.6) | 0.001 |
History | |||||
Hypertension, n (%) | 475 | (60.5%) | 107 | (67.7%) | 0.089 |
Diabetes mellitus, n (%) | 101 | (12.9%) | 23 | (14.6%) | 0.566 |
Hypercholesterolaemia, n (%) | 285 | (36.3%) | 41 | (25.9%) | 0.013 |
Smoking: | |||||
– Current, n (%) | 87 | (11.1%) | 16 | (10.1%) | 0.725 |
– Past, n (%) | 69 | (8.8%) | 12 | (7.6%) | 0.625 |
Myocardial infarction, n (%) | 90 | (11.5%) | 18 | (11.4%) | 0.979 |
Coronary artery disease, n (%) | 140 | (17.8%) | 27 | (17.1%) | 0.823 |
Percutaneous coronary intervention, n (%) | 81 | (10.3%) | 16 | (10.2%) | 0.962 |
Coronary artery bypass graft, n (%) | 59 | (7.5%) | 3 | (1.9%) | 0.009 |
Valve surgery, n (%) | 42 | (5.6%) | 4 | (1.3%) | 0.021 |
Stroke | |||||
– Ischaemic, n (%) | 36 | (4.6%) | 3 | (1.9%) | 0.122 |
– Haemorrhagic, n (%) | 0 | (0%) | 1 | (0.6%) | 0.168 |
Transient ischaemic attack, n (%) | 31 | (3.9%) | 9 | (5.7%) | 0.320 |
Pulmonary embolism, n (%) | 8 | (1.0%) | 1 | (0.6%) | >0.999 |
Deep venous thrombosis, n (%) | 2 | (0.2%) | 3 | (1.9%) | 0.036 |
Congenital heart disease, n (%) | 10 | (1.3%) | 2 | (1.3%) | >0.999 |
Hyperthyroidism, n (%) | 18 | (2.3%) | 7 | (4.4%) | 0.168 |
Hypothyroidism, n (%) | 19 | (2.4%) | 5 | (3.2%) | 0.588 |
Chronic obstructive pulmonary disease, n (%) | 30 | (3.8%) | 1 | (0.6%) | 0.040 |
Peripheral artery disease, n (%) | 26 | (3.3%) | 7 | (4.4%) | 0.485 |
Obstructive sleep apnoea syndrome, n (%) | 18 | (2.3%) | 5 | (3.2%) | 0.569 |
Atrial flutter, n (%) | 89 | (11.3%) | 23 | (14.6%) | 0.254 |
ICD, n (%) | 29 | (3.7%) | 2 | (1.2%) | 0.118 |
PM, n (%) | 20 | (2.5%) | 4 | (2.5%) | >0.999 |
Ablation therapy for AF, n (%) | 87 | (11.1%) | 12 | (7.6%) | 0.192 |
CHA2DS2-VASc (±SD) | 2.6 | (±1.6) | 2.7 | (±1.5) | 0.370 |
Medication at baseline | |||||
Vitamin K antagonist, n (%) | 281 | (35.8%) | 41 | (25.9%) | 0.017 |
Direct oral coagulants, n (%) | 144 | (18.3%) | 32 | (20.3%) | 0.574 |
Other medication | |||||
Acetylsalicylic acid, n (%) | 88 | (11.2%) | 23 | (14.6%) | 0.234 |
ACE inhibitors, n (%) | 142 | (18.1%) | 27 | (17.1%) | 0.765 |
ARB, n (%) | 246 | (31.3%) | 50 | (31.8%) | 0.900 |
Spironolactone, n (%) | 19 | (2.4%) | 2 | (1.3%) | 0.556 |
Beta-blocker, n (%) | 353 | (45.0%) | 68 | (43.0%) | 0.656 |
Digoxin, n (%) | 37 | (4.7%) | 5 | (3.2%) | 0.388 |
AAD use, n (%) | 231 | (29.4%) | 39 | (24.7%) | 0.229 |
Statin, n (%) | 303 | (38.6%) | 56 | (35.4%) | 0.449 |
Echocardiographya | |||||
LAV index <42 ml/m2, n (%) | 317 | (47.8%) | 84 | (61.3%) | 0.004 |
Normal RAV index ml/m2, n (%) | 258 | (32.9%) | 66 | (41.8%) | 0.031 |
LVH, n (%) | 248 | (31.6%) | 47 | (29.7%) | 0.648 |
LVEF (±SD) | 59.5 | (±7.5) | 61.6 | (±5.0) | 0.002 |
AF characteristics | |||||
First-detected AF, n (%) | 251 | (32.0%) | 66 | (41.8%) | 0.017 |
Duration of symptoms <24 h, n (%) | 534 | (68.0%) | 143 | (90.5%) | <0.001 |
Mean systolic blood pressure, mm Hg (±SD) | 135.0 | (±20.4) | 134.2 | (±26.2) | 0.735 |
Mean diastolic blood pressure, mm Hg (±SD) | 85.0 | (±15.1) | 82.2 | (±14.9) | 0.044 |
Palpitations, n (%) | 565 | (72.0%) | 129 | (81.6%) | 0.012 |
Dyspnoea, n (%) | 232 | (29.6%) | 28 | (17.7%) | 0.002 |
Fatigue, n (%) | 72 | (9.2%) | 5 | (3.2%) | 0.064 |
Near-collapse, n (%) | 48 | (6.1%) | 18 | (11.4%) | 0.018 |
Chest pain, n (%) | 146 | (18.6%) | 44 | (27.8%) | 0.008 |
Dizziness, n (%) | 117 | (14.9%) | 32 | (20.3%) | 0.093 |
Other symptoms of AF, n (%) | 79 | (10.1%) | 16 | (10.1%) | 0.981 |
ECG | |||||
Heart rate, bpm (±SD) | 118 | (±27) | 125 | (±29) | 0.004 |
QRS duration, ms (±SD) | 94 | (±21) | 96 | (±25) | 0.356 |
LBBB, n (%) | 21 | (2.7%) | 6 | (4.7%) | 0.260 |
QTc, ms (±SD) | 452 | (±34) | 460 | (±34) | 0.035 |
Laboratory results | |||||
Potassium, mmol/l (n = 877) (±SD) | 4.2 | (±0.5) | 4.2 | (±0.6) | 0.277 |
Creatinine, umol/l (n = 578) (±SD) | 95.3 | (±42.7) | 104.7 | (±103.4) | 0.142 |
Haemoglobin, mmol/l (n = 423) (±SD) | 8.6 | (±1.1) | 8.4 | (±1.2) | 0.094 |
TSH, mU/l (n = 516) (±SD) | 2.6 | (±5.9) | 2.9 | (±3.6) | 0.602 |
Cardioversion
Spontaneous conversion
Univariable | Multivariable | |||||||
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Non-SCV, n = 785 | SCV, n = 158 | p-value | OR | 95% CI | p-value | |||
Demographics | ||||||||
BMI | 28.5 | (±6.5) | 27.0 | (±4.6) | 0.001 | 0.9 | 0.91–0.99 | 0.028 |
Presentation characteristics | ||||||||
Duration <24 h | 534 | (68.0%) | 143 | (90.5%) | <0.001 | 7.7 | 3.5–17.2 | <0.001 |
First-detected AF | 251 | (32.0%) | 66 | (41.8%) | 0.017 | 2.5 | 1.6–3.9 | <0.001 |
Near-collapse | 48 | (6.1%) | 18 | (11.4%) | 0.018 | 2.4 | 1.2–5.1 | 0.018 |
Echo- and electrocardiography | ||||||||
QTc (ms) | 452 | (±34) | 460 | (±34) | 0.035 | 1.01 | 1.00–1.02 | 0.002 |
LAV index <42 ml/m2 | 317 | (47.8%) | 84 | (61.3%) | 0.004 | 1.8 | 1.2–2.8 | 0.010 |