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

Figures & data

Table 1 Baseline Characteristics According to EHRA Score

	N=744	EHRA I (311)	EHRA II (363)	EHRA III/IV (70)	p
Age	63 ± 10	62 ± 9	64 ± 10	65 ± 11	0.004
Female	169 (22.7%)	45 (14.5%)	100 (27.5%)	24 (34.3%)	<0.0001
DM	143 (19.2%)	48 (15.4%)	77 (21.2%)	18 (25.7%)	0.06
Hypertension	446 (59.9%)	169 (54.3%)	237 (65.3%)	40 (57.1%)	0.013
COPD	77 (10.3%)	25 (8%)	44 (12.1%)	8 (11.4%)	0.212
Structural heart disease	222 (29.8%)	61 (19.6%)	125 (34.4%)	36 (51.4%)	<0.0001
Prior stroke	41 (5.5%)	14 (4.5%)	25 (6.9%)	2 (2.9%)	0.237
Duration of AF
Persistent AF	509 (68.4%)	185 (59.5%)	271 (74.6%)	53 (75.7%)	<0.0001
Long-standing persistent AF (>1 year)	132 (17.7%)	69 (22.2%)	55 (15.2%)	8 (11.4%)
Unknown	103 (13.8%)	57 (18.3%)	37 (10.2%)	9 (12.9%)
CHA2DS2VASC
<2	304 (40.9%)	160 (51.4%)	125 (34.4%)	19 (27.1%)	<0.0001
≥2	440 (59.1%)	151 (48.6%)	238 (65.6%)	51 (72.9%)
HASBLED
<2	555 (74.6%)	243 (78.1%)	265 (73%)	47 (66.1%)	0.101
≥2	189 (25.4%)	68 (21.9%)	98 (27%)	23 (32.9%)
NYHA classification
I	648 (87.1%)	307 (98.7%)	297 (81.8%)	44 (62.9%)	<0.0001
II, III, IV	96 (12.9%)	4 (1.3%)	66 (18.2%)	26 (37.1%)
LVEF (%)	57 ± 11	59 ± 9	56 ± 12	49 ± 16	<0.0001
LA diameter	44 ± 6	44 ± 6	43 ± 6	46 ± 6	0.032
Antiarrhythmic therapy
Flecainide/propafenone	77 (10.3%)	41 (13.2%)	32 (8.8%)	4 (5.7%)	0.593
Amiodarone	216 (29%)	83 (26.7%)	116 (32%)	17 (24.3%)
Other	19 (2.6%)	9 (2.9%)	9 (2.5%)	1 (1.4%)
Other treatment
Betablockers	465 (62.5%)	181 (58.2%)	234 (64.5%)	50 (71.4%)	0.066
Calcium blockers	133 (17.9%)	56 (18%)	67 (18.5%)	10 (14.3%)	0.704
Digoxin	76 (10.2%)	23 (7.4%)	42 (11.6%)	11 (15.7%)	0.057
ACEi/ARB	390 (52.4%)	150 (48.2%)	199 (54.8%)	41 (58.6%)	0.129

Abbreviations: ACEi, angiotensin-converting enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin receptor blocker; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; LA; left atrium; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.

Figure 1 Mean EHRA score at baseline and after 6 months of follow-up in the study population, in patients who maintained sinus rhythm, and in patients who experienced recurrence of AF.

Figure 2 Change in EHRA at 6 months after cardioversion in patients who maintained sinus rhythm and in patients with recurrence of AF.

Table 2 Univariable and Multivariable Linear Regression Analysis for Prediction of Change in EHRA Score

	Univariable		Multivariable
	β	p value	β	p value
Age (years)	–0.012	0.74	–	–
Female sex	–0.07	0.055	–0.61	0,1
Structural heart disease	–0.112	0.002	–0.23	0.584
NYHA classification ≥2	–0.214	<0.0001	–0.178	<0.0001
LVEF	–0.146	<0.0001	–0.065	0,128
Maintenance of SR	–0.17	<0.0001	–0.162	<0.0001
Antiarrhythmic treatment	–0.096	0.09	–	–

Abbreviations: LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; SR, sinus rhythm.