TY - JOUR
T1 - Clinical determinants of early spontaneous conversion to sinus rhythm in patients with atrial fibrillation
AU - Pluymaekers, N.A.H.A.
AU - Dudink, E.A.M.P.
AU - Weijs, B.
AU - Vernooy, K.
AU - Hartgerink, D.E.J.
AU - Jacobs, J.S.
AU - Erkuner, O.
AU - Marcks, N.G.H.M.
AU - van Cauteren, Y.J.M.
AU - Dinh, T.
AU - ter Bekke, R.M.A.
AU - Sels, J.E.M.W.
AU - Delnoij, T.S.R.
AU - Geyik, Z.
AU - Driessen, R.G.H.
AU - Linz, D.K.
AU - den Uijl, D.W.
AU - Crijns, H.J.G.M.
AU - Luermans, J.G.L.M.
N1 - Funding Information:
J.G.L.M. Luermans reports a consultancy agreement with Medtronic, outside the scope of the submitted work. K. Vernooy reports grants from Medtronic, Abbott, and Biotronik, outside the scope of the submitted work. H.J.G.M. Crijns reports financial support from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodeling, and Vascular destabilisation in the progression of AF (RACE V). N.A.H.A. Pluymaekers, E.A.M.P. Dudink, B. Weijs, D.E.J. Hartgerink, J.S. Jacobs, Ö. Erküner, N.G.H.M. Marcks, Y.J.M. van Cauteren, T. Dinh, R.M.A. ter Bekke, J.E.M.W. Sels, T.S.R. Delnoij, Z. Geyik, R.G.H. Driessen, D.K. Linz and D.W. den Uijl declare that they have no competing interests.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/5
Y1 - 2021/5
N2 - Background The current standard of care for acute atrial fibrillation (AF) focuses primarily on immediate restoration of sinus rhythm by cardioversion, although AF often terminates spontaneously.Objective To identify determinants of early spontaneous conversion (SCV) in patients presenting at the emergency department (ED) because of AF.Methods An observational study was performed of patients who visited the ED with documented AF between July 2014 and December 2016. The clinical characteristics and demographics of patients with and without SCV were compared.Results We enrolled 943 patients (age 69 +/- 12 years, 47% female). SCV occurred within 3 h of presentation in 158 patients (16.8%). Logistic regression analysis showed that duration of AF <24 h [odds ratio (OR) 7.7, 95% confidence interval (CI) 3.5-17.2, p < 0.001], left atrial volume index <42 ml/m(2) (OR 1.8, 95% CI 1.2-2.8, p = 0.010), symptoms of near-collapse at presentation (OR 2.4, 95% CI 1.2-5.1, p = 0.018), a lower body mass index (BMI) (OR 0.9, 95% CI 0.91-0.99, p = 0.028), a longer QTc time during AF (OR 1.01, 95% CI 1.0-1.02, p = 0.002) and first-detected AF (OR 2.5, 95% CI 1.6-3.9, p < 0.001) were independent determinants of early SCV.Conclusion Early spontaneous conversion of acute AF occurs in almost one-sixth of admitted patients during a short initial observation in the ED. Spontaneous conversion is most likely to occur in patients with first-onset, short-duration AF episodes, lower BMI, and normal left atrial size.
AB - Background The current standard of care for acute atrial fibrillation (AF) focuses primarily on immediate restoration of sinus rhythm by cardioversion, although AF often terminates spontaneously.Objective To identify determinants of early spontaneous conversion (SCV) in patients presenting at the emergency department (ED) because of AF.Methods An observational study was performed of patients who visited the ED with documented AF between July 2014 and December 2016. The clinical characteristics and demographics of patients with and without SCV were compared.Results We enrolled 943 patients (age 69 +/- 12 years, 47% female). SCV occurred within 3 h of presentation in 158 patients (16.8%). Logistic regression analysis showed that duration of AF <24 h [odds ratio (OR) 7.7, 95% confidence interval (CI) 3.5-17.2, p < 0.001], left atrial volume index <42 ml/m(2) (OR 1.8, 95% CI 1.2-2.8, p = 0.010), symptoms of near-collapse at presentation (OR 2.4, 95% CI 1.2-5.1, p = 0.018), a lower body mass index (BMI) (OR 0.9, 95% CI 0.91-0.99, p = 0.028), a longer QTc time during AF (OR 1.01, 95% CI 1.0-1.02, p = 0.002) and first-detected AF (OR 2.5, 95% CI 1.6-3.9, p < 0.001) were independent determinants of early SCV.Conclusion Early spontaneous conversion of acute AF occurs in almost one-sixth of admitted patients during a short initial observation in the ED. Spontaneous conversion is most likely to occur in patients with first-onset, short-duration AF episodes, lower BMI, and normal left atrial size.
KW - acute atrial fibrillation
KW - cardioversion
KW - determinants
KW - obesity
KW - propafenone
KW - risk
KW - spontaneous conversion
KW - treatment
KW - wait-and-see approach
KW - Acute atrial fibrillation
KW - PROPAFENONE
KW - CARDIOVERSION
KW - Cardioversion
KW - RISK
KW - Wait-and-see approach
KW - OBESITY
KW - Treatment
KW - Determinants
KW - Spontaneous conversion
U2 - 10.1007/s12471-020-01528-5
DO - 10.1007/s12471-020-01528-5
M3 - Article
C2 - 33410120
SN - 1568-5888
VL - 29
SP - 255
EP - 261
JO - Netherlands Heart Journal
JF - Netherlands Heart Journal
IS - 5
ER -