Risk factors for recurrence of persistent and long-standing persistent atrial fibrillation within 12 months after scheduled restoration of sinus rhythm
Objective. To determine the risk factors for arrhythmia recurrence after scheduled cardioversion in patients with persistent and long-standing persistent atrial fibrillation (AF) and to assess the impact of circulating biomarkers of fibrosis and inflammation on the risk of arrhythmia recurrence. Design and methods. The study included 122 patients with persistent and long-standing persistent AF who underwent either electrical cardioversion (n = 61) or pharmacologic cardioversion (cavutilide) (n = 61). The study groups were matched in terms of sex, age, and clinical characteristics. Prospective follow-up of patients was carried out for 12 months after cardioversion. Results. The efficacy of electrical cardioversion and pharmacologic cardioversion with cavutilide was comparable (53/61 (86,9 %) vs. 52/61 (85,2 %), p = 0,794). The frequency of AF recurrence within 12 months after cardioversion did not depend on the method of sinus rhythm restoration and was 31/53 (58,5 %) in the electrical cardioversion group and 26/52 (50,0 %) among patients who underwent pharmacologic cardioversion (p = 0,383). Further analysis was conducted in groups of patients with arrhythmia recurrence and those maintaining sinus rhythm for 12 months after cardioversion. The most significant clinical predictors of AF recurrence were metabolic syndrome and congestive heart failure. Analysis of instrumental and laboratory data established that patients with arrhythmia recurrence had more severe atrial dilation, diastolic dysfunction, larger values of epicardial fat thickness, and higher concentrations of blood biomarkers of fibrosis and inflammation. According to multivariate regression analysis of echocardiographic parameters, the most significant predictors of recurrence were the left atrial volume index (LAVI) and epicardial fat thickness. An increase in LAVI greater than 49,5 mL/m² increased the risk of AF recurrence after cardioversion by 2,2 times (relative risk (RR) — 2,215, 95 % confidence interval (CI) 1,396–3,517, p < 0,001), and an epicardial fat thickness greater than 4,55 mm increased the risk of arrhythmia recurrence by 2,4 times (RR — 2,420, 95 % CI 1,570–3,731, p < 0,001). Analysis of laboratory parameters revealed that the concentration of growth differentiation factor 15 (GDF-15) was most strongly associated with the risk of AF recurrence within 12 months after cardioversion (Beta — 0,001, odds ratio — 1,001, 95 % CI 1,001–1,002, p < 0,001). A blood concentration of GDF-15 more than 2432,6 pg/ml increased the risk of arrhythmia recurrence within one year by 2,6 times (RR — 2,593, 95 % CI 1,510–4,451, p < 0,001). Conclusion. The most significant predictors of arrhythmia recurrence within 12 months after cardioversion in patients with persistent and long-standing persistent AF are the following: metabolic syndrome, congestive heart failure, LAVI, epicardial fat thickness, and serum GDF-15 concentration.