To determine the role of lavi in prediction of conversion to sinus rythm and maintanence of sinus rythm after cardioversion in non-valvular atrial fibrillation patients who are planned to cardioversion and to compare the lavi parameter with the left atrial diameter parameter calculated with m-mode echocardiography in terms of prediction of the clinical results

To determine the role of LAVI in prediction of conversion to sinus rythm and maintanence of sinus rythm after cardioversion in non-valvular atrial fibrillation patients who are planned to cardioversion and to compare the LAVI parameter with the left atrial diameter parameter calculated with M-mode echocardiography in terms of prediction of the clinical results. Between August 2009 and May 2011, 120 patients with non-valvular atrial fibrillation were evaluated before cardioversion in Akdeniz University Cardiology outpatient clinic. And 80 patients (38 male, 42 female) who met the inclusion criteria were evaluated in the study. After echocardiographic evaluation suitable patients were hospitalized. After sedation with IV midazolam, as designated by the ACC/AHA/ESC guidelines, DCC was performed with Hewlett Packard codemaster DC monophasic defibrillator device with anterolateral approach. The DCC was performed for each patient starting with 200J and in case of unsuccess the CV was performed with increasing the energy to 300J and 360J respectively. And in case of unsuccess the CV was again performed with 360 J with anteroposterior approach. The cardioversion procedure was accepted as unsuccesfull if sinus rythm could not be achieved despite all attempts. Patients were monitorized after procedure for 24 hours. At the end of 24 hours, if sinus rythm were maintained patients were accepted in group 1 (successfull cardioversion), if not accepted in group 2 (unsuccessfull cardioversion). Patients in group 1 were accepted in group 1A (not recurrent) if the sinus rythm was maintained at the end of 1 month, if not accepted in group 1B (recurrent). Univariate and multivariate logistic regression analysis were performed to determine the factors which influence the success of cardioversion. In univariate logistic regression analysis, the age, LA diameter and LAVI were found to be significant factors influencing the cardioversion success. However in multivariate logistic regression analysis only the LAVI and LVMI were found to be important parameters which influence the cardioversion success. For each 1 ml/m² increase in LAVI, the cardioversion success was found to decrease 8%, and this was independent from other parameters (OR 1,08, CI 1,035-1,124, p< 0,0001). To predict the success of cardioversion, the LA diameter and LAVI parameters were compared with ROC analysis. The area under curve for LAVI 0,892±0,041 and for LA diameter it was 0,712±0,058. The area under curve for both of the parameters were statistically significant (LA diameter and LAVI, p:0,002 and p:<0,001 respectively). The most distinctive LAVI value to estimate the success of cardioversion was found as 40.5 ml/m² (sensitivity: 97%, specifity: %88). The most distinctive LA diameter value to estimate the cardioversion succes was found as 46,5 mm (sensistivity: 73%, specifity: 63%). The LAVI parameter were found to be more specific and sensitive than the LA diameter to estimate the cardioversion success (p:0,0008). Univariate and multivariate logistic regression analysis were performed to estimate the recurrence of atrial fibrillation. In univariate analysis the age, sex, BMI, LVMI, LA diameter and LAVI were found to be statistically significant predictors of recurrence. However in multivariate analysis only the LAVI was found to be statistically signficant predictor of recurrence. For each 1 ml/m² increase in LAVI, the recurrence risk was found to be increase 16% (OR 1,16, CI 1,018-1,329, p< 0,027) and this was independent from other parameters. The area under curves of LA diameter and LAVI with ROC analysis were compared. The area under curve for LAVI was 0,950±0,029 and for LA diameter it was 0,762±0,076. The area under curve for both of the parameters were found to be statistically significant (LA diameter and LAVI, p:0,004 ve p:<0,001). The most distinctive LAVI value to estimate the reccurence of AF was found as 36 ml/m² (sensitivity: 100%, specifity: 82,5%). The most distinctive LA diameter value to estimate the recurrence of AF was found as 41 mm (sensitiviy: 90%, specifity: 50%). The LAVI parameter were found to be more specific and sensitive than the LA diameter to estimate the recurrence of AF. The LAVI parameter is a simple, repeatable, quantitative method to estimate the success of cardioversion and to estimate the recurrence of AF after cardioversion in non-valvular AF patients whom the cardioversion was planned. Besides this, the LAVI is more sensitive and specific parameter than the LA diameter to predict the cardioversion success and to predict the recurence of AF. The results of our study needs to be supported by further clinical studies.