Improvement in Atrial Fibrillation-Related Symptoms After Cardioversion: Role of NYHA Functional Class and Maintenance of Sinus Rhythm

María Ferré Vallverdú; Carmen Ligero; Rafael Vidal-Pérez; Antoni Martínez‐Rubio; Xavier Viñolas; Josep M. Alegret

doi:10.2147/cia.s305619

April 1, 2021Clinical Interventions in AgingOpen Access

Improvement in Atrial Fibrillation-Related Symptoms After Cardioversion: Role of NYHA Functional Class and Maintenance of Sinus Rhythm

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Why the study?

Little was known about the variables related to the European Heart Rhythm Association score and how it changes after cardioversion for atrial fibrillation.

Does maintenance of sinus rhythm after elective cardioversion improve patient-reported atrial fibrillation symptoms in patients with AF?

Structured PICO

Does maintenance of sinus rhythm after elective cardioversion improve patient-reported atrial fibrillation symptoms in patients with AF?

P

Population

744 patients undergoing elective cardioversion for atrial fibrillation

I

Intervention

Elective cardioversion with maintenance of sinus rhythm

C

Comparator

Patients with recurrent atrial fibrillation episodes at 6 months

O

Outcome

Change in atrial fibrillation-related symptoms assessed by the EHRA score at 6 months follow-uppatient reported

Maintenance of sinus rhythm and worse baseline NYHA functional class are independent predictors of significant improvement in patient-reported AF symptoms 6 months after elective cardioversion.

Implication

SR maintenance after cardioversion was associated with fewer symptoms; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

BACKGROUND: The European Heart Rhythm Association (EHRA) score is a proven and validated tool for assessing the symptoms of atrial fibrillation (AF). Little is known about the variables related to this score and how it changes after cardioversion. METHODS: We analyzed 744 patients undergoing elective cardioversion in whom AF-related symptoms were assessed at baseline and after 6 months of follow-up using the EHRA score. We assessed the association between the EHRA score and other clinical and echocardiographic variables at baseline and after 6 months of follow-up. RESULTS: At 6 months of follow-up, we observed a reduction in the EHRA score in 50% and worsening in 2.8% of patients who remained in sinus rhythm (SR) compared with 34.6% and 11.3%, respectively, of patients with AF episodes (p<0.0001). Patients who maintained SR at 6 months were less symptomatic than those with AF (EHRA score 1.13 ± 0.35 vs 1.42 ± 0.59; p<0.0001). The independent predictors for reduction in the EHRA score after cardioversion were NYHA ≥II at baseline and maintenance of SR (p<0.0001). CONCLUSION: The greatest improvement in AF-related symptoms was in patients who remained in SR at 6 months after cardioversion and in patients with worse NYHA functional class at baseline.