Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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The Impact of Right Atrial Size to Predict Success of Direct Current Cardioversion in Patients With Persistent Atrial Fibrillation

  • Christoph Doring (Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden) ;
  • Utz Richter (Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden) ;
  • Stefan Ulbrich (Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden) ;
  • Carsten Wunderlich (Department of Internal Medicine II, Helios Hospital Pirna) ;
  • Micaela Ebert (Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden) ;
  • Sergio Richter (Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden) ;
  • Axel Linke (Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden) ;
  • Krunoslav Michael Sveric (Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden)
  • Received : 2022.10.20
  • Accepted : 2023.02.08
  • Published : 2023.05.01
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Abstract

Background and Objectives: The prognostic implication of right atrial (RA) and left atrial (LA) size for an immediate success of direct current cardioversion (DCCV) in atrial fibrillation (AF) remains unclear. This study aimed to compare RA and LA size for the prediction of DCCV success. Methods: Between 2012 and 2018, 734 consecutive outpatients were screened for our prospective registry. Each eligible patient received a medical history, blood analysis, and transthoracic echocardiography with a focus on indexed RA (iRA) area and LA volume (iLAV) prior to DCCV with up to three biphasic shocks (200-300-360 J) or additional administration of amiodarone or flecainide to restore sinus rhythm. Results: We enrolled 589 patients, and DCCV was in 89% (n=523) successful. Mean age was 68 ± 10 years, and 40% (n=234) had New York heart association class >II. A prevalence of the male sex (64%, n=376) and of persistent AF (86%, n=505) was observed. Although DCCV success was associated with female sex (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.06-3.65), with absence of coronary heart disease and normal left ventricular function (OR, 2.24; 95% CI, 1.26-4.25), with short AF duration (OR, 1.93; 95% CI, 1.05-4.04) in univariable regression, only iRA area remained a stable and independent predictor of DCCV success (OR, 0.27; 95% CI, 0.12-0.69; area under the curve 0.71), but not iLAV size (OR, 1.16; 95% CI, 1.05-1.56) in multivariable analysis. Conclusions: iRA area is superior to iLAV for the prediction of immediate DCCV success in AF.

Keywords

Acknowledgement

We want to thank MD Manja Hubald, MD Stefanie Jellinghaus and MD Julia Mayer for their help in the execution of this study.

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