Risk factors of failed electrical cardioversion in patients with persistent or long-standing persistent atrial fibrillation : A multicenter retrospective cohort study = 지속성 또는 장기간 지속성 심방세동 환자에서 전기적 심율동전환 실패의 위험인자 : 다기관 후향적 코호트 연구

다국어 초록 (Multilingual Abstract)

Objectives: Identifying the clinical risk factors of failed electrical cardioversion (ECV) for persistent or long-standing persistent atrial fibrillation (AF) can guide the selection of rhythm control.
Methods: A total of 1,058 patients who underwent ECV for persistent or long-standing persistent AF at multiple centers were retrospectively reviewed. Patients were divided into three groups: group 1 maintained sinus rhythm (SR) for >1 year, group 2 maintained SR ≤1 year after ECV, and group 3 had failed ECV. SR maintenance was assessed via regular electrocardiography follow-ups or Holter monitoring.
Results: Group 1, 2 and 3 comprised 315 (30%), 654 (62%), and 89 (8%) patients, respectively. The mean patient age was 61±10 years, with males accounting for 78% (824). AF duration was longer in group 3 [59.5±47.6 months vs. 37.2±35.4 (group 1) and 47.1±39.2 (group 2), p=0.000]. Group 3 showed female dominance, high proportion of patients with history of coronary artery disease (CAD) and heart failure (HF), and increased left atrium (LA) diameter, LA volume index (LAVI), cardiac size, and cardiothoracic ratio. Class I and III antiarrhythmics were prescribed more frequently in group 2. Univariate analysis revealed that AF duration (≥50 months), female sex, history of CAD and HF, increased LA diameter (≥45 mm) and LAVI (≥45 mL/m2), and no antiarrhythmics were risk factors of failed ECV for persistent or long-standing persistent AF. Among them, AF duration (≥50 months), history of HF, and increased LAVI showed clinical significance in the multivariate analysis.
Conclusions: Longer AF duration, history of HF, and increased LAVI were strongly associated with failed ECV in patients with persistent or long-standing persistent AF.

국문 초록 (Abstract)

목적: 지속성 또는 장기간 지속성 심방세동(AF)에서 전기적 심율동전환 (ECV) 실패 위험을 예측하는 것은 리듬 조절 전략 선택에 중요하다.
방법: 본 연구는 다기관에서 전기적 심율동전환을 시행한 1,058명을 후 향적으로 분석하였으며, 전환 후 1년 초과 동율동(SR) 유지군, 1년 이하 유지군, 실패군으로 분류하였다.
결과: 실패군은 더 긴 심방세동 기간, 여성 비율 증가, 관상동맥질환 및 심부전 병력, 확장된 좌심방 직경과 좌심방 용적지수(LAVI)를 보였다. 일변량 분석에서 심방세동 기간 ≥50개월, 여성, 관상동맥질환 및 심부전 병력, 좌심방 직경 ≥45 mm, 좌심방 용적지수 ≥45 mL/m², 항부정맥 제 미사용이 위험인자로 확인되었고, 다변량 분석에서는 심방세동 기간 ≥50개월, 심부전 병력, 좌심방 용적지수 ≥45 mL/m²가 유의하였다.
결론: 지속성 또는 장기간 지속성 심방세동 환자에서 심방세동 기간이 길 고 심부전 병력이 있으며 좌심방 용적지수가 증가한 경우 전기적 심율동 전환 실패와 강하게 연관되었다.

목차 (Table of Contents)

• Ⅰ. Introduction 1
• 1. Background 1
• Ⅱ. Objectives 4
• 1. Ultimate objective 4
• 2. Specific objective 4
• Ⅲ. Materials and Methods 6
• 1. Materials (Study design and population) 6
• 2. Methods (Procedures and management) 7
• 3. Methods (Clinical definition and major complications) 9
• 4. Statistical analysis 10
• Ⅵ. Results 12
• 1. General characteristics of the study population 12
• 2. Characteristics of AF and measurement outcomes 12
• 3. Major complications 13
• 4. Characteristics of medication use 14
• 5. Analysis of risk factors 14
• Ⅴ. Discussion 16
• 1. Summary of main findings 16
• 2. Clinical implication 16
• 3. Comparison with previous study 17
• 4. Clinical stratification by AF-HF sequence 18
• 5. Analysis of complications 20
• 6. Study limitations 21
• Ⅵ. Conclusion 23
• References 24