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

Clin Interv Aging. 2021 Apr 29:16:739-745. doi: 10.2147/CIA.S305619. eCollection 2021.

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.

Keywords: EHRA score; NYHA functional class; atrial fibrillation; cardioversion; sinus rhythm; symptoms improvement.

MeSH terms

  • Aged
  • Atrial Fibrillation / physiopathology*
  • Atrial Fibrillation / therapy*
  • Echocardiography
  • Electric Countershock / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spain

Grants and funding

This work was supported by Bayer Health Care Spain.“The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”“All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.”