PMID- 14607452
OWN - NLM
STAT- MEDLINE
DCOM- 20031204
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 42
IP  - 9
DP  - 2003 Nov 5
TI  - Spontaneous conversion of patients with atrial fibrillation scheduled for 
      electrical cardioversion: an ACUTE trial ancillary study.
PG  - 1638-43
AB  - OBJECTIVES: This study was designed to determine the characteristics and outcomes 
      of spontaneous conversion (SC) to sinus rhythm (SR) in patients with atrial 
      fibrillation (AF) of more than two days. BACKGROUND: The Assessment of 
      Cardioversion Using Transesophageal Echocardiography (ACUTE) multicenter study 
      was a prospective trial in which transesophageal echocardiography (TEE)-guided 
      treatment was compared with conventional anticoagulation treatment for the 
      management of patients with AF >2 days undergoing direct current cardioversion 
      (DCC). In an ancillary analysis, we evaluated the baseline and outcome data in 
      patients who underwent SC to SR before scheduled DCC. METHODS: We identified 
      1,041 patients for this analysis after excluding patients on pre-existing 
      antiarrhythmic agents. Patients with SC in the TEE-guided and conventional groups 
      were first compared then pooled and compared with non-spontaneous conversion 
      (No-SC) patients. RESULTS: Overall, 167 of 1,041 (16%) patients underwent SC, 
      with twice as many in the conventional compared with the TEE-guided group 
      (110/523 [21%] vs. 57/518 [11%]; p < 0.001). When compared with No-SC patients, a 
      higher proportion of SC patients maintained SR at eight weeks (87.2% vs. 48.9%, p 
      < 0.001), without statistically significant differences in bleeding, 
      thromboembolism or mortality. Multivariate predictors of SC were shorter duration 
      of AF, New York Heart Association (NYHA) functional class 1 or 2, smaller left 
      atrial size, and absence of left atrial spontaneous echo contrast. CONCLUSIONS: 
      Spontaneous conversion was associated with shorter duration of AF, lower NYHA 
      class, smaller left atrial size, and absence of left atrial spontaneous echo 
      contrast. There was a better SR outcome in the SR group, but no differences in 
      the other clinical end points. The conventional treatment strategy allowed 
      greater opportunity for SC. In the absence of favorable predictors of SC, the 
      TEE-guided approach should be considered.
FAU - Tejan-Sie, S Ahmed
AU  - Tejan-Sie SA
AD  - Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio 44195, 
      USA.
FAU - Murray, R Daniel
AU  - Murray RD
FAU - Black, Ian W
AU  - Black IW
FAU - Jasper, Susan E
AU  - Jasper SE
FAU - Apperson-Hansen, Carolyn
AU  - Apperson-Hansen C
FAU - Li, Jianbo
AU  - Li J
FAU - Lieber, Elizabeth A
AU  - Lieber EA
FAU - Grimm, Richard A
AU  - Grimm RA
FAU - Klein, Allan L
AU  - Klein AL
CN  - ACUTE Investigators
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - *Atrial Fibrillation/diagnostic imaging/physiopathology
MH  - Echocardiography, Transesophageal
MH  - Electric Countershock
MH  - Logistic Models
MH  - Prospective Studies
MH  - ROC Curve
MH  - Randomized Controlled Trials as Topic
MH  - Remission, Spontaneous
EDAT- 2003/11/11 05:00
MHDA- 2003/12/05 05:00
CRDT- 2003/11/11 05:00
PHST- 2003/11/11 05:00 [pubmed]
PHST- 2003/12/05 05:00 [medline]
PHST- 2003/11/11 05:00 [entrez]
AID - S0735109703011173 [pii]
AID - 10.1016/j.jacc.2003.06.008 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2003 Nov 5;42(9):1638-43. doi: 10.1016/j.jacc.2003.06.008.