Factors influencing the maintenance of sinus rhythm one year after cardioversion in patients with persistent atrial fibrillation

Introduction. Pharmacological or electrical cardioversion is recommended for the elective restoration of sinus rhythm in patients with persistent atrial fibrillation (AF). However, predictors of long-term sinus rhythm maintenance following cardioversion are insufficiently studied.
Objective. To determine the impact of clinical and echocardiographic parameters on the risk of AF recurrence after cardioversion.
Materials and methods. The study included 105 patients with persistent and long-standing persistent AF who underwent successful cardioversion. Prospective follow-up was conducted for 12 months post-cardioversion to identify arrhythmia recurrence.
Results. AF recurrence within 12 months after elective cardioversion was observed in 57/105 (54.3%) patients. According to multivariate regression analysis with stepwise exclusion of less significant predictors, achieving target blood pressure levels (beta -1.088, OR 0.153, 95% CI 0.048-0.490, p = 0.002) and target lipid profile parameters (beta -1.250, OR 0.286, 95% CI 0.089-0.920, p = 0.036) reduced the likelihood of AF recurrence, while an increase in left atrial volume index (beta 0.079, OR 1.082, 95% CI 1.032-1.133, p = 0.001) increased the risk of arrhythmia recurrence. The use of sodium-glucose cotransporter 2 inhibitors in patients with congestive heart failure contributed to the maintenance of sinus rhythm for 12 months after cardioversion.
Conclusion. Achieving target blood pressure and lipid profile parameters before cardioversion reduces the risk of AF recurrence, whereas a significant increase in left atrial volume index promotes arrhythmia recurrence within 12 months after successful cardioversion.

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