{
  "abstract": "Background Atrial fibrillation (AF) is a prevalent heart arrhythmia affecting millions worldwide. In 2016, the Global Burden of Disease project estimated that approximately 46.3 million individuals globally were living with AF. 1 Treatment options include electrical cardioversion (ECV) to restore sinus rhythm. However, success rates at follow up have been reported to be low and influenced by a range of factors. The aim of this study was to determine which factors play a role in the outcome, when assessed at the post cardioversion follow up appointment.Purpose To identify and analyse the factors which predict the successful maintenance of normal sinus rhythm following undergoing elective electrical cardioversion.Methods This is a single center, retrospective study, we reviewed the electronic medical records of all patients who underwent elective electrical cardioversion for atrial fibrillation from February 2022 to December 2023. Post cardioversion follow ups (mean of 9.5 weeks) were done by the arrhythmia specialist nurse and cardiology consultants in order to document the follow up outcome. The primary outcome of this study was to determine the relationship between left atrial (LA) size and the recurrence of atrial fibrillation. To achieve this, two key measurements were analysed, LA diameter and LA volume index. The secondary outcomes included: 1- Assessing the correlation between the duration of AF and the follow-up outcome. 2-Investigating whether obesity serves as a predictive factor for the follow-up outcome. This outcome-driven approach aims to enhance the understanding of AF recurrence predictors, contributing to improved clinical management and risk stratification in affected patients. Given that normality was not assumed, a non-parametric analysis was utilised to compare baseline characteristics.Results A total of 200 patients were included in this study, of which 108 (54%) were found to have reverted back into AF on their follow up (mean 9.5 weeks). Analysis of baseline comorbidities, left ventricular function, and obesity did not reveal any significant predictive potential for AF recurrence. However, left atrial size, particularly the LA volume index, emerged as a clinically significant factor. Notably, 70% of patients in the severe LA volume index category experienced AF recurrence at follow-up (p = 0.009). While LA diameter demonstrated a similar trend, it lacked statistical significance (p = 0.221). Additionally, AF duration showed strong predictive value, with 60.5% of patients who had been in AF for more than 12 months reverting back to AF on follow up, reinforcing its role as a potential prognostic marker. Anti-arrhythmic treatment and rate control prior to cardioversion also did not show any predictive potential in this study.Conclusion This study highlights the clinical significance of LA size and AF duration as key predictors of AF recurrence following elective electrical cardioversion. These findings align with the concept that structural and electrophysiological remodeling of the left atrium plays a crucial role in AF recurrence. 2 Identifying patients with severe LA enlargement or prolonged AF duration may help in better risk stratification and individualized treatment planning, potentially guiding alternative rhythm management strategies such as early catheter ablation or long-term anticoagulation therapy.3 Further large-scale, prospective studies are warranted to validate these findings and refine AF management strategies, particularly in patients with high-risk LA characteristics.Abstract 4-003 Table 1Abstract 4-003 Table 2References American Heart Association. Global burden of atrial fibrillation: Insights from the Global Burden of Disease Study 2016 . Circulation Research, 2020;127(4),315–340. Available at: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.316340 [Accessed 28 Feb. 2025].Kim D, Yang PS, Lee KN, et al. The role of left atrial volume index in predicting atrial fibrillation recurrence after catheter ablation. Journal of the American College of Cardiology, 2021;77(10):1225–1235.Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 2017;14(10):e275-e444.",
  "authors": [
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Trust, Sheffield, UK"
      ],
      "name": "Mamoon Ahmed"
    },
    {
      "affiliations": [
        "Rotherham General Hospital NHS Trust, Rotherham, UK"
      ],
      "name": "Shadan Muzafar Jan"
    },
    {
      "affiliations": [
        "Rotherham General Hospital NHS Trust, Rotherham, UK"
      ],
      "name": "Laura Burley"
    },
    {
      "affiliations": [
        "Rotherham General Hospital NHS Trust, Rotherham, UK"
      ],
      "name": "Simon Smith"
    }
  ],
  "title": "4-003 Impact of left atrial dimensions, prevalent comorbidities, and atrial fibrillation duration on cardioversion outcomes: a real-world study",
  "uid": "ac8fff6b-717b-5e6a-8255-45b20a3f1525"
}