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CNAA / Theses / 2004 / June /

The evolution of atrial fibrillation after cardioversion and the effect of Amiodarone and angiotensin-converting enzyme inhibitor‘s treatment in prevention of recurrences


Author: Larisa Sclearov
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2004
Scientific adviser: Aurel Grosu
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Institution:
Scientific council:

Status

The thesis was presented on the 16 June, 2004
Approved by NCAA on the 14 October, 2004

Abstract

Adobe PDF document – 0.46 Mb / in romanian

Keywords

atrial fibrillation, cardioversion, sinus rhythm, recurrences, Amiodarone, angiotensin-converting enzyme inhibitor, mechanical dysfunction of atria, factors predicting

Summary

The study included 218 patients with persistent atrial fibrillation lasting 5.3±0.5 months. The follow-up period was 36.2±2.1 months after the external cardioversion. The patients were examined by clinical tests, in all patients were performed 12 leads ECG, EcoCG and Doppler EcoCG.

The study have investigate the role of treatment with Amiodaron and Enalapril in prevention of recurrences of atrial fibrillation during the postconversion period. The benefice of postconversion treatment was appreciated comparing the groups who received Amiodaron and Enalapril (34 pts), only Amiodaron (33 pts) and patients without treatment (51 pts).

The rhythm control treatment in the postconversion period increased the rate of maintenance of sinus rhythm at the end of the first year of follow-up in patients with lone atrial fibrillation (from 43.8% to 61%) and in patients with structural heart diseases (from 36.2% to 51.4%). In patients who received Amiodaron with Enalapril was observed a reduced incidence of recurrences of atrial fibrillation reaching 26.5% at 6 months and 43.1% at 12 months comparing with patients who received only Amiodaron – 36.2% and respectively 50.2%, and patients without anti-arrhythmic treatment – 43.1% and respectively 54.6%.

As a result were determined the parameters with significant role in maintenance of sinus rhythm during the first month of follow-up: the lasting of last episode of atrial fibrillation, the aetiology and presence of anti-arrhythmic treatment.

The correlative analyse of EcoCG parameters and the duration of maintenance of sinus rhythm showed a direct proportional relation between the duration of maintenance of sinus rhythm and maximum velocity of A wave in diastolic transmitral flow after one month after cardioversion in patients who did not received Enalapril in postconversion period (factor of correlation average, direct correlation, p<0.05).