Abstract：
BACKGROUND: Paroxysmal atrial fibrillation (pAF) may progress through cardiac remodeling to persistent atrial fibrillation (psAF). However, some may present in psAF without a preceding history of pAF. A preceding history of pAF may affect recurrence after direct current cardioversion (DCCV).
OBJECTIVE: The aim of this study was to determine whether a preceding history of pAF is associated with a difference in recurrence rates after DCCV compared with patients without a preceding history of pAF.
METHODS: A prospective procedural database at a Veterans Affairs center identified 565 patients who underwent their first DCCV for psAF. Initial rhythm history was separated by prior pAF, and those with none were considered primary psAF. Electrocardiography follow-up was standardized at 1 month and 3 months after cardioversion.
RESULTS: Patients who underwent their first DCCV for psAF were more likely to have presented with primary psAF (81.6%). Those with pAF had a similar left atrial size but were more likely to have chronic kidney disease, sleep apnea, previous stroke, and use of antiarrhythmic drugs at the time of cardioversion. Patients with pAF had earlier recurrence and shorter median AF survival time, 1.6 months compared with 5 months (Kaplan-Meier plot, P = .0101). This difference persisted in controlling for antiarrhythmic drug use. Recurrence type was mostly persistent AF, similar in both groups.
CONCLUSIONS: Patients with primary psAF may have a more sustained response to DCCV compared with those with a preceding history of pAF. Thus, those patients with pAF may benefit from a more aggressive, early rhythm control strategy because of higher likelihood of recurrence with DCCV.
OBJECTIVE: The aim of this study was to determine whether a preceding history of pAF is associated with a difference in recurrence rates after DCCV compared with patients without a preceding history of pAF.
METHODS: A prospective procedural database at a Veterans Affairs center identified 565 patients who underwent their first DCCV for psAF. Initial rhythm history was separated by prior pAF, and those with none were considered primary psAF. Electrocardiography follow-up was standardized at 1 month and 3 months after cardioversion.
RESULTS: Patients who underwent their first DCCV for psAF were more likely to have presented with primary psAF (81.6%). Those with pAF had a similar left atrial size but were more likely to have chronic kidney disease, sleep apnea, previous stroke, and use of antiarrhythmic drugs at the time of cardioversion. Patients with pAF had earlier recurrence and shorter median AF survival time, 1.6 months compared with 5 months (Kaplan-Meier plot, P = .0101). This difference persisted in controlling for antiarrhythmic drug use. Recurrence type was mostly persistent AF, similar in both groups.
CONCLUSIONS: Patients with primary psAF may have a more sustained response to DCCV compared with those with a preceding history of pAF. Thus, those patients with pAF may benefit from a more aggressive, early rhythm control strategy because of higher likelihood of recurrence with DCCV.
摘要：
背景：阵发性心房颤动（pAF）可能通过心脏重塑发展为持续性心房颤动（psAF）。然而,有些可能出现在psAF中，而没有pAF的历史。先前的pAF病史可能会影响直流电复律（DCCV）后的复发。
目的：确定与没有pAF既往史的患者相比，pAF既往史是否与DCCV术后复发率的差异相关。
方法：退伍军人事务中心的前瞻性程序数据库确定了565例首次接受PSAFDCCV的患者。最初的节律病史被先前的pAF分开，没有的人被认为是原发性psAF。心电图随访在复律后1和3个月进行标准化。
结果：首次接受PSAFDCCV的患者更有可能出现原发性PSAF（81.6%）。那些有pAF的人有相似的左心房大小，但更有可能患有慢性肾病，睡眠呼吸暂停,以前的行程，并在复律时使用抗心律失常药物。pAF患者复发较早，中位房颤生存时间较短，1.6个月与5个月相比(Kaplan-Meier图p=0.0101)。当控制AAD使用时，这种差异仍然存在。复发类型多为持续性房颤,两组相似。
结论：与先前有pAF病史的患者相比，原发性psAF患者对DCCV的反应可能更持久。因此，那些患有pAF的患者可能会从更具攻击性的药物中受益，早期心律控制策略，由于DCCV复发的可能性较高。
目的：确定与没有pAF既往史的患者相比，pAF既往史是否与DCCV术后复发率的差异相关。
方法：退伍军人事务中心的前瞻性程序数据库确定了565例首次接受PSAFDCCV的患者。最初的节律病史被先前的pAF分开，没有的人被认为是原发性psAF。心电图随访在复律后1和3个月进行标准化。
结果：首次接受PSAFDCCV的患者更有可能出现原发性PSAF（81.6%）。那些有pAF的人有相似的左心房大小，但更有可能患有慢性肾病，睡眠呼吸暂停,以前的行程，并在复律时使用抗心律失常药物。pAF患者复发较早，中位房颤生存时间较短，1.6个月与5个月相比(Kaplan-Meier图p=0.0101)。当控制AAD使用时，这种差异仍然存在。复发类型多为持续性房颤,两组相似。
结论：与先前有pAF病史的患者相比，原发性psAF患者对DCCV的反应可能更持久。因此，那些患有pAF的患者可能会从更具攻击性的药物中受益，早期心律控制策略，由于DCCV复发的可能性较高。
