Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion

Although electrical cardioversion (CV) is effective in restoring sinus rhythm in patients with atrial fibrillation (AF), AF frequently recurs in spite of antiarrhythmic medications. We investigated the predictors of failed CV and AF recurrence after successful CV. In 81 patients (M:F = 63:18, 59.1 +/- 10.5 years old) with AF who underwent CV, clinical, image, and CV findings (energy requirement, immediate recurrence of AF < 15 min), and pre-CV serological markers were evaluated. Results: (i) During 13.1 +/- 10.6 months of follow-up, 8.6% (7/81) showed failed CV, 59.26% (48/81) showed AF recurrence, and 32.1% (26/81) remained in sinus rhythm (no recurrence). (ii) Failed CV showed higher plasma levels of transforming growth factor (TGF)-beta (P = 0.0260) than those with successful CV. (iii) Patients with AF recurrence were older (60.4 +/- 9.0 years old vs. 55.3 +/- 12.5years old, P = 0.0220), had a higher incidence of spontaneous echo contrast (SEC; 68.1 vs. 40.0%, P = 0.0106), a lower prescription rate of angiotensin-converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB; 27.0 vs. 50.0%, P = 0.0248) or spironolactone (0.0 vs. 19.2%, P = 0.0007), and lower plasma levels of stromal cell-derived factor (SDF)-1 alpha (P = 0.0105). Post-CV recurrence commonly occurs in patients with age > 60 years, SEC, under-utilization of ACE-I/ARB or spironolactone, and low plasma levels of SDF-1 alpha. High plasma level of TGF-beta predicts failed CV.